Extrait

Background and study aims Hepatitis B and C are blood-borne viruses that affect the liver. Long-term (chronic) infection with hepatitis B or C (HBV and HCV) is the leading cause of end-stage liver disease (cirrhosis) and primary liver cancer worldwide. In the UK, the rates of hospital admissions and serious complications due to hepatitis C (HCV) continues to rise year on year, with HCV now being the leading cause of liver transplantation in Europe and North America. Chronic infection with HBV and HCV seems more common in certain groups of people (at-risk groups), and due to several risk factors. Case-finding is the process by which at-risk individuals are identified and offered testing for viral hepatitis. As chronic infection typically causes few symptoms, it is important that those at-risk are offered testing to identify the virus early. Good effective treatment exists for both HBV and HCV, with several new treatments for hepatitis C released in the past year. Identification and treatment will eliminate or reduce the chances of disease progression, and this is the goal of case-finding. National and international guidance exists to support case-finding and insists on identifying those groups who should be offered testing for HBV and HCV in England. A key target of these recommendations is to increase testing in GP practices. As the majority of those infected with viral hepatitis lie in the community, offering testing to people in GP practices is priority. There is however no recommended strategy, and little research to guide GPs on how best to identify and offer testing to at-risk individuals in their practice. At the same time, most GP practices are finding it difficult to meet the existing service commitments, with no additional resources provided for case-finding. Developing and proving effective and acceptable case-finding strategies in GP practices is therefore a priority. Who can participate? GP practices with suitable computer recording software and those with links to hepatology speciality services. What does the study involve? In this study we will look at 3 different testing strategies for GP practices to identify and offer testing to individuals with increased risk of viral hepatitis, in comparison to current practice. GPs will be asked to identify and offer testing for viral hepatitis to their patients in one of three ways: systematic, opportunistic or new-patient testing, in comparison to a group of (control) GP practices undertaking usual testing practice. At-risk groups will be identified. In the Systematic arm of the study, we will identify at-risk groups within the GP practice, and write to offer them HBV and HCV testing. In the Opportunistic arm of the study, GPs will offer testing to at-risk individuals who present to their GP for related, or unrelated consultations, and in the New-patient arm of the study, new patient registrations will be asked additional questions to identify risk factors that would merit a testing offer for HBV or HCV. Testing is optional, and we will record the uptake of testing in each arm, in comparison to testing uptake in the control GP practices. What are the benefits and risks of participating? The main benefit of the study is to help improve the detection of those infected with viral hepatitis, with the aim of treatment before complications arise. The study will also help improve our understanding of the number of at-risk individuals in GP practices, and in this population the actual numbers infected with viral hepatitis. We do not expect any undue risks for participants by taking part in this study. Testing will be at their wish, and participants will be given the opportunity for further discussions if they so wish before testing. Where is the study run from? The study will be conducted in local GP practices. When is the study starting and how long is it expected to run for? November 2014 to February 2015. Who is funding the study? Gilead Sciences Inc (USA) Who is the main contact? Dr Sanju Mathew [email protected]

Critère d'inclusion

• Topic: Primary Care; Subtopic: Hepatology, Primary care; Disease: All Diseases

Liens

• isrctn
• ictrp