Referral

Referral to specialist care should be considered for all patients with active HCV infection (HCV RNA positive) and not restricted to potential candidates for antiviral therapy. Specialist clinics are often a source of information for patients and relatives, including health promotion and methods of avoiding secondary transmission of the virus.Recent modelling suggests that 90% of individuals with HCV in Scotland are current or former IDU.1 Factors associated with injecting drug use (eg poverty, chaotic lifestyle, comorbidity, including alcohol dependence) can be obstacles to individuals navigating their way through and remaining in investigation, referral and treatment pathways.14, 18 Expert consensus suggests that uptake of services may be improved by integrated multidisciplinary care which also addresses, for example, individuals’ alcohol and drug use problems simultaneously with their HCV specialist care. No evidence was identified supporting the prevailing view that the investigation and treatment of current IDU with HCV infection should not be promoted because they are unlikely to have progressed to at least moderate hepatitis, or are unlikely to adhere to such care.Two observational studies and one five year follow-up study have shown that IDU, described as “active” at the time of enrolment and undergoing management of their drug problem, complied with antiviral treatment to the same degree as those who had never injected drugs.40-42 These studies were small and no details of participants’ injecting behaviour were provided.2-All patients with acute HCV should be referred to specialist care immediately as treatment given during the acute phase is more likely to be successful (see Treatment of patients with acute hepatitis C).431++Ideally the specialist clinic should be integrated with other services by means of outreach clinics so that the patient journey is seamless, especially for those who find it difficult to access medical care. Such integration should encourage agencies such as drug problems services and prison medical services to positively and repeatedly address the issue of HCV infection.

Individuals, including injecting drug users, diagnosed with chronic HCV should be offered integrated multidisciplinary care as it can maximise their uptake of, and retention in, services.

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