Variation in Hepatitis C services may lead to inequity of heath-care provision: a survey of the organisation and delivery of services in the United Kingdom

A cross-sectional questionnaire survey of consultant members of British Association for the Study of the Liver (n = 53), Infectious Disease consultants (n = 43), and a 1 in 5 sample of Genito-Urinary Medicine (n = 48) and gastroenterologists (n = 200).Response rate was 70%. 40% of respondents provided a comprehensive service (included treatment and follow-up): speciality of clinical leads identified as Hepatology (37%); Gastroenterology (47%); and Infectious Disease (16%). The estimated number of patients managed by respondents was about 23,000 with an upward trend over the previous 3 years. There was variation between comprehensive service providers, including unit size, eligibility criteria for treatment, and drug regimes. Key barriers to quality of care identified were staffing capacity, funding of treatment and patient non-attendance. Most English strategic health authorities had at least one comprehensive service provider.There was significant variation in all aspects of the patient pathway which may contribute to inequity of health care provision. Services need to be expanded to form geographical clinical networks, and properly resourced to ensure greater uptake and more equitable delivery of services if the future burden of chronic liver disease is to be reduced.Chronic Hepatitis C (CHC) is a major cause of serious liver disease[1,2]. Effective viral eradication therapy using combinations of anti-viral agents is available [3,4] and guidance for their use in the UK has been issued [5,6]. Since the screening of blood donors for hepatitis C (HCV) was introduced, the main risk groups are ex and current injecting drug-users (IDUs), who are hard to reach by health care services.National Strategies for Hepatitis C in the UK have been published [7-9]. These recognize the need for a systematic approach to the identification, testing, referral, selection for treatment and follow-up of HCV positive patients. They recommend the establishment of managed clinical networks