Quality statement 4: Blood-borne viruses

Quality statement

People accessing drug treatment services are offered testing and referral for treatment for hepatitis B, hepatitis C and HIV and vaccination for hepatitis B.

Rationale

Blood-borne viruses can cause chronic poor health and can lead to serious disease and premature death. Rates of infection with blood-borne viruses are high among people with drug use disorders, specifically those who inject drugs. Vaccination can protect against hepatitis B and carrying out testing to diagnose infection with blood-borne viruses is the first step in preventing transmission and accessing treatment.

Quality measure

Structure:

a) Evidence of local arrangements to ensure people accessing drug treatment services are offered testing for hepatitis B, hepatitis C and HIV, and referral for treatment if positive.

b) Evidence of local arrangements to ensure people accessing drug treatment services are offered vaccination for hepatitis B.

Process:

a) Proportion of people accessing drug treatment services, not known to have hepatitis B, who receive testing for hepatitis B.

Numerator – the number of people in the denominator receiving testing for hepatitis B.

Denominator – the number of people accessing drug treatment services not known to have hepatitis B.

b) Proportion of people accessing drug treatment services who test positive for hepatitis B and are referred for treatment.

Numerator – the number of people in the denominator referred for treatment for hepatitis B.

Denominator – the number of people accessing drug treatment services who test positive for hepatitis B.

c) Proportion of people accessing drug treatment services, not known to have hepatitis C, who receive testing for hepatitis C.

Numerator – the number of people in the denominator receiving testing for hepatitis C.

Denominator – the number of people accessing drug treatment services not known to have hepatitis C.

d) Proportion of people accessing drug treatment services who test positive for hepatitis C and are referred for treatment.

Numerator – the number of people in the denominator referred for treatment for hepatitis C.

Denominator – the number of people accessing drug treatment services who test positive for hepatitis C.

e) Proportion of people accessing drug treatment services, not known to have HIV, who receive testing for HIV.

Numerator – the number of people in the denominator receiving testing for HIV.

Denominator – the number of people accessing drug treatment services not known to have HIV.

f) Proportion of people accessing drug treatment services who test positive for HIV and are referred for treatment.

Numerator – the number of people in the denominator referred for treatment for HIV.

Denominator – the number of people accessing drug treatment services who test positive for HIV.

g) Proportion of people accessing drug treatment services who are vaccinated against hepatitis B (either by the service or previously).

Numerator – the number of people in the denominator who are vaccinated against hepatitis B.

Denominator – the number of people accessing drug treatment services who are not known to have hepatitis B.

Outcome:

Rate of hepatitis B infection in people with drug use disorders.

Rate of hepatitis C infection in people with drug use disorders.

What the quality statement means for each audience

Service providers ensure systems are in place for people accessing drug treatment services to be offered testing and referral for treatment for hepatitis B, hepatitis C and HIV, and vaccination for hepatitis B.

Healthcare professionals ensure people accessing drug treatment services are offered testing and referral for treatment for hepatitis B, hepatitis C and HIV, and vaccination for hepatitis B.

Commissioners ensure they commission services that offer people accessing drug treatment services testing and referral for treatment for hepatitis B, hepatitis C and HIV, and vaccination for hepatitis B.

People accessing drug treatment services are offered tests and, if needed, referral for treatment for hepatitis B, hepatitis C and HIV, and vaccination for hepatitis B.

Source guidance

NICE clinical guideline 51 recommendation 1.3.1.1.

Drug misuse and dependence: UK guidelines on clinical management sections 6.2.2 and 6.2.4.

Data source

Structure: a) and b) Local data collection.

Process:

c), d) and g) Local data collection. The National Drug Treatment Monitoring System collects data on all clients receiving specialist treatment for their drug use; 'Hep C tested', 'Hep C intervention status', 'Hep C positive?', 'Referred for hepatology', 'Hep B vaccination count' and 'Hep B intervention status' are collected.

a), b), e) and f) Local data collection.

Outcome: Local data collection.

Definitions

The term 'accessing drug treatment services' is defined as being in contact with any drug service, including needle and syringe programmes.

Testing should not be performed only once. It should be repeated when necessary because a person's situation may change.

People with drug use disorders who are vaccinated against hepatitis B should receive the full course, which consists of 3 injections of hepatitis B vaccine over a period of 4 to 6 months.