Audit of bloodborne virus prevention activity with drug users seen in primary care.

Abstract

Drug misuse is increasingly being managed in general practice. It has been proposed that better use could be made of this contact to identify people with bloodborne virus (BBV) morbidity and to deliver prevention strategies. The Hepatitis B and C Prevention Project was designed to enhance the work of primary healthcare teams in preventing transmission of BBVs in people known to have a history of problem drug use. As part of this work a baseline audit of current provision was undertaken and the results are reported here. Primary care records of 1278 people with a history of illicit drug use were audited to establish the levels of hepatitis B immunisation and testing for BBVs and to determine whether there was a record of any professional discussion of BBV issues with the patient. Records were drawn from rural and city-based general practices. Audit feedback, training, and advice were offered to raise awareness and discussion of how this work was currently being undertaken, and how it might be improved. This baseline audit showed that 90% (n = 1153) of the patients had been questioned about injecting drug use and of these 50% (579/1153) reported injecting at some point in the past. Only 4% (54/1278) had completed a course of hepatitis B immunisation and of these three quarters gave a history of injecting drug use. Another 6% (74/1278) of patients tested for hepatitis B virus (HBV) showed markers of natural immunity. Up to 90% of this group therefore remained vulnerable to this preventable disease. A discussion of BBV issues with a professional was recorded in41% (523/1278) of cases, and was more likely to have occurred in those with a known history of injecting. Individuals were less likely to have been tested for hepatitis C virus (HCV) than for HIV or HBV despite its high prevalence in this group. Only 28% (354/1278) were tested for HCV compared with 33% (416/1278) tested for HBV and 36% (454/1278) tested for HIV. Prevalence of anti-HCV for people with a history of injecting was 51% (137/268) compared to 11% (9/83) in those with no history of injecting. Prevalence of anti-HIV in those with a history of injecting was 10% (29/294) compared 0.7% (1/137) in those with no history of injecting. Prevalence of HBV markers in those with a history of injecting was 23% (65/279) compared with 7% (8/114) in those with no history of injecting. Of the 530 patients with test results, only 52% (275/530) had been tested for all three viruses despite the common transmission routes.