Section 3 Testing
3.1 The role of testing is absolutely crucial in any attempt to tackle Hepatitis C. People infected with the virus have to be tested and diagnosed before they can be referred to specialist treatment and support services. However, testing can also play an important role in prevention. The process of testing (including the pre- and post-test discussion) may be used to educate and inform individuals about how the virus is spread, and thus, how they can avoid contracting it or passing it on to others.
3.2 Any individual who feels they may be, or in the past, may have been, at risk of Hepatitis C may request a free test from their GP. Confidential testing services are also available through many sexual health clinics, needle exchange facilities, drug treatment services and some voluntary sector agencies in Scotland. The difficulty is that many individuals who may be infected, or who may be at risk of contracting the virus, are not aware of it, and so would not ordinarily seek to be tested. In addition, many come forward for testing, but never return for their result.
3.3 Actions to raise awareness of the importance of testing, and to improve its accessibility are already underway in many areas of Scotland - particularly in relation to injecting drug users. For example:
- From April 2006, the SMR25 form, which collects detailed information on new individuals entering drug treatment services, asks whether an individual has ever had a test for Hepatitis C. It is expected that this will lead to an increase in testing among this population.
- The Scottish Prison Service ( SPS) has been offering testing to prisoners is some prisons for a number of years. An audit of current practice in relation to the detection of Hepatitis C in prisons was published in August and will inform further developments within the prison service in relation to Hepatitis C testing and treatment.
- Some areas have begun to make use of Enhanced Services funding under the new General Medical Services ( GMS) contract to develop and improve services for current and former injecting drug users, including Hepatitis C testing.
- Specialist (non-pharmacy) and outreach needle exchanges in a number of areas of Scotland have employed highly-trained Blood-borne Virus Nurses to deliver vaccination and testing services. In most cases, these nurses make direct referrals to specialist treatment services for individuals whose tests are positive.
- Many needle exchange services in Scotland offer information, advice and support to injectors before and after Hepatitis C testing.
3.4 These developments are extremely encouraging, but the situation across Scotland is patchy. In addition, more must be done to educate health and social care professionals about the benefits and importance of testing. Actions related to this are described in Section 5 of this Action Plan.
3.5 Furthermore, stakeholders from around Scotland have highlighted that lack of funding is hampering local efforts to make testing more accessible and to identify the large numbers of individuals who may have the virus, but who are undiagnosed.
3.6 To inform a bid for new funding to improve the accessibility of testing, work will be undertaken to identify and describe testing and laboratory services in Scotland, examine the way they work, measure the numbers of people being tested, and look at where new resources are needed to expand or improve existing facilities. This will form part of a larger needs assessment exercise described in more detail in the next section. One aspect of this work will look at the feasibility and cost of making testing more widely available through different types of community-based services across Scotland.
3.7 Section 5 of this Action Plan describes work that will be undertaken to improve the knowledge and understanding that health and social care professionals have about Hepatitis C. It is expected that this will lead to more accurate and consistent messages being communicated to individuals in pre- and post-test discussions.
3.8 In the meantime, local NHS boards and community health partnerships should consider what further work they can do, using the funding allocated over the two years of this action plan, to improve the accessibility of testing services in their area, and to encourage those who are at risk of Hepatitis C (particularly those who are current or former injectors) to come forward for testing.
Actions on Testing
From Sept 2006 - Aug 2008
NHS Boards should consider what further work they can do, using the funding allocated over the two years of this action plan, to improve the accessibility of testing services in their area, and to identify and offer Hepatitis C testing to those who are at risk.
By Sep 2007
Following publication of the SIGN Guideline on Hepatitis C (expected by December 2006), the Scottish Prison Service will develop a blood-borne virus strategy for the care of prisoners.
By Oct 2007
Health Protection Scotland will complete a two-year study to determine the cost-effectiveness of different screening approaches for Hepatitis C. An interim report of this work will be made available to the Scottish Executive by October 2006.
By Oct 2007
The Scottish Executive will report on work undertaken to describe the existing provision of testing and laboratory services across Scotland, and to investigate the options and costs of making testing services more accessible.
By Dec 2007 and annually
The Information Services Division ( ISD) will publish statistics on the number of individuals entering treatment for problem drug use who have ever been tested for Hepatitis C. This data will be presented by NHS Board.