FROM TESTING TO TREATMENT: final report action Hepatitis C

De Regenboog Groep conducted a hepatitis C testing campaign in 2017/18 among residents in the Social Care and walk-in centres of De Regenboog Groep.

In the attached PDF (download) you can see how we did it and what the results were. We are happy to provide the conclusion below:

CONCLUSION

The completed risk checklists show that the majority of respondents were at risk of HCV (Hepatitis C Virus) through injecting drug use (12%), through unprotected sex between men (MSM) (20%), placing tattoos in a non-official shop or in a country with high prevalence HCV(20%), and/or sharing a base coke pipe (29%).

Only a quarter of respondents have ever been tested for HCV. Among respondents with active hepatitis C, the greatest dropout from testing to successful treatment is in the high-risk group of (ever) injecting drug users. The test result found for anti-HCV is 9.8%. This is significantly higher than the prevalence of anti-HCV in the Netherlands (0.2-0.4%). Residents/visitors of MO and walk-in centres therefore belong to a risk group for hepatitis C and, according to the Health Council's advice, should be detected through the general practitioner and other medically responsible health care providers.

In this study of 225 clients of the MO and Walk-in Centres, 10 persons (4.4%) have active hepatitis C (HCV-RNA positive). Of the 10 persons who are HCV-RNA positive, 3 persons (30%) have indicated that they do not want treatment; 4 persons (40%) have been referred to the hospital; 2 persons (20%) have just/nearly completed treatment; and 1 person (10%) is already under hospital control but cannot yet receive treatment. Of the 4 persons referred, 1 person did not go to the specialist and 1 person did not start treatment. A high dropout rate (50%) was observed between testing for HCV antibodies and treatment. In our opinion, this has two causes:

1) Individual causes of hepatitis

Client indicates he/she does not want to be further tested or treated. This was the reason in 3/10 individuals (30%) who were HCV-RNA positive and in 4/7 individuals (57%) who were not tested for HCVRNA but were anti-HCV positive.

2) Structural causes of hepatitis

3/7 clients (42.8%) were not tested for HCV-RNA after a positive result for anti-HCV when there was no question that these clients did not want to be tested. In this study, at the screening site, immediately after the anti-HCV result, blood could not be drawn by the GGD nurse to test for HCV-RNA and it took the GGD nurse extra time to ensure that blood was drawn from eligible individuals.

In our opinion, it is a problem that the GGD does not apply a standard procedure for this given the fact that employees involved work in the Social and Mental Health Department and the Infectious Diseases Department is not designated to test this target group. Five times the blood sample taken was lost at the laboratory. For 2 persons, this was a reason to refrain from further blood sampling. For 1 person, the general practitioner failed to summon the person to be tested.