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
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

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
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

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

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

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
SAMPLE DEMOGRAPHICS
Lifetime
history of
IV drug use
No history of
IV drug use
Missing
data
Male
87% (104)
9% (11)
Female
71% (22)
29% (9)
Mean age
11.6 years
11.5 years
18-25 years old
89% (16)
5.5% (1)
1
26+ years old
83% (110)
14 % (19)
3
Tested in Primary
Care
88 % (61)
12% (7)
1
Tested in Secondary
Care
87% (60)
10% (7)
3
Sample size
126 clients
20 clients
Missing clients
4 clients
TESTING FOR HEPATITIS B, HEPATITIS C
AND HIV (TOTAL SAMPLE)
Hep B
Hep C
HIV
Ever tested
95% (143)
95% (143)
93% (140)
Tested in last
year
33% (49)
32% (48)
29% (44)
Not tested in last
year
34% (51)
35.5% (53)
54% (80)
Never tested
4% (5)
4 % (5)
4 % (6)
Not tested in last
year as no risk
factors
16% (25)
15.5% (24 )
2 %(3)
Offered testing
but no venous
access
6% (9)
6% (9)
4% (6)
Missing data
7% (11)
7% (11)
7% (11)
Total sample
150
TESTING FOR HEPATITIS B, HEPATITIS
C AND HIV IN THOSE WITH A LIFETIME
HISTORY OF IV DRUG MISUSE
Hep B
Hep C
HIV
Ever tested
96% (121)
96% (121)
94 % (118)
Tested in last
year
34% ( 43)
33% (42)
31% (39)
Not tested in last
year
37% (45)
38% (47)
53% (67)
Never tested
0.8% (1)
0.8% (1)
1.6% (2)
Not tested in last
year as no risk
factors
14% (18)
13% (17)
2.4 % (3)
Offered testing
but no venous
access
6.2% (8)
6.2% (8)
4% (5)
Missing data
8 %(11)
8%(11)
8% (10)
Total sample
150
150
150
RESULTS HEPATITIS B, HEPATITIS
C AND HIV IN TOTAL SAMPLE
Hep B
Hep C
HIV
Never infected
92% (137)
76.5% (115)
91%(136)
Infected and
spontaneous
resolution
1.3% (2)
0.7% (1)
N/A
Infected
resolution
following
treatment
0.7% (1)
13% (19)
0
Infected and in
ongoing treatment
0
2.8% (4)
0
Infected and
never in
treatment
0
2% (3)
0
Never Tested
5.6% (8)
5% (8)
5% (8)
RESULTS HEPATITIS C TESTING IN
TOTAL SAMPLE BY AGE
18-25 years
26+ years
Male
Female
Male
Female
Never infected
72% (10)
75% (3)
79% (83)
70% (19)
Infected and
spontaneous
resolution
0
0
0
4% (1)
Infected resolution
following treatment
14% (2)
0
11% (12)
19% (5)
Infected and in
ongoing treatment
7% (1)
0
3% (3)
0
Infected and never
in treatment
0
0
3% (3)
0
Never Tested
7% (1)
25% (1)
2% (2)
7% (2)
2 Missing,(2%)
RESULTS HEPATITIS B, HEPATITIS C
AND HIV IN THOSE WITH LIFETIME
HISTORY OF IV DRUG USE
Hep B
Hep C
HIV
Never infected
94% (118)
78% (97)
94% (119)
Infected and
spontaneous
resolution
1.6% (2)
0.8% (1)
N/A
Infected
resolution
following
treatment
0.8% (1)
14% (18)
0
Infected and in
ongoing treatment
0
3.2% (4)
0
Infected, never in
Treatment
0
2% (3)
0
Never Tested
2.4% (3)
2% (3)
4% (5)
Anti-HBsAg levels
0-9
mIU/ML
10-99
mIU/ML
100+
mIU/ML
Missing
data
Lifetime
history of
IV drug use
14% (16)
9% (10)
26% (30)
51% (64)
Noninjectors
7% (1)
7% (1)
14% (2)
72% (26)
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
