An Audit of Hepatitis B, Hepatitis C, HIV testing and uptake of Hepatitis B vaccination within the NHSCT Opiod Substit

1. An Audit of Hepatitis B, Hepatitis C, HIV testing and uptake of Hepatitis B vaccination within the NHSCT Opiod Substitution Treatments Prescribing Service Lynn Agnew, Christine Byrne, Annelies McCurley, Billy Gregg, Conall McCaughey and Key Workers at Railway Street Addiction Service Ballymena NI Hepatitis C Network Update 24th June 2011

2. Background • Evidence vast majority of IVDUs offered testing for BBVs at least once:- • Data from Drug Misuse Database • Unlinked anonymous testing screening • Previous audits by NHSCT • Evidence of retesting within last year not reassuring • About 50% are unaware of their past or current Hepatitis C infection • Hepatitis B vaccination histories often uncertain

3. Estimated prevalence rates for Hepatitis C in current or former injecting drug users in NI (2009) 2009 Hepatitis C “Of the participating injecting drug users, 28%1 (26%, 40 of 153) had antibodies to hepatitis C.” “The majority, 92% (131 of 143), reported having ever had a voluntary confidential test for hepatitis C.” “Just over half (52%, 16 of 31) of the participating injecting drug users who had antibodies to hepatitis C were aware of their infection.” Source: Unlinked Anonymous Monitoring Survey of Injecting Drug Users Summary of the findings for 2009 from the two collaborating services in Northern Ireland: Health Protection Agency

4. Background • NHSCT Addiction Services prescribe opiate substitute treatments (OST) primarily for heroin dependence but also for dependence on other opiods. • Clients treated in secondary care and also primary care within a shared care scheme • Currently no facilities for testing for BBVs in at Railway Street Clinic Ballymena. • Testing for BBVs dependent on testing by primary care or if admitted to Addiction Unit Holywell Hospital

5. Background • NHSCT Addiction Services prescribe opiate substitute treatments (OST) primarily for heroin dependence but also for dependence on other opiods. • Clients treated in secondary care and also primary care within a shared care scheme • Currently no facilities for testing for BBVs at Railway Street Clinic Ballymena. • Testing for BBVs dependent on testing by primary care or if admitted to Addiction Unit Holywell Hospital

6. Audit Standards • Minimum standards for BBVs testing for those with risk factors • 100% to be offered screening for Hepatitis B, Hepatitis C and HIV • 100% to be offered screening tests at least yearly if ongoing risk factors • 100% to be offered Hepatitis B vaccination • 100% to achieve Anti-HBsAg titres > 100 mIU/ML

7. Method • Key Worker completed a BBV testing and Hepatitis B status summary with clients March –June 2011 • Written consent obtained from client to access results of any previous BBV / Anti-HBs test results held by Primary Care or Regional Virus Laboratory • Test results subsequently obtained from Regional Virus Laboratory • Data on 150 of total caseload of 236 currently available • Current data includes 126 with lifetime history of IV drug use

8. Sample demographics

9. Testing for Hepatitis B, hepatitis C and HIV (total sample)

10. TESTING FOR HEPATITIS B, HEPATITIS C AND HIV IN THOSE WITH A LIFETIME HISTORY OF IV DRUG MISUSE

11. RESULTS HEPATITIS B, HEPATITIS C AND HIV IN TOTAL SAMPLE

12. RESULTS HEPATITIS C TESTING IN TOTAL SAMPLE BY AGE

13. RESULTS HEPATITIS B, HEPATITIS C AND HIV IN THOSE WITH LIFETIME HISTORY OF IV DRUG USE

14. Anti-HBsAg levels

15. Summary • Need to improve access to testing for BBVs and Hepatitis B vaccination for all services in contact with IV drug users • Repeat testing remains a concern • Dry blood spot testing or saliva testing may be helpful where venous access is poor or blood samples are not maintained • Consider introducing incentives to encourage testing – NICE guidelines are being drafted • Anti-HBs titres not completed in majority of cases – clearer guidance required