Pre-test discussion can be carried out by any suitably informed health professional. It need not be lengthy, subject to the needs of individual patients, as long as information is provided in a clear and concise way that the patient can understand.
Pre-test discussion should cover the following areas:
■ confidentiality of test results.
■ modes of transmission.
■ the nature of hepatitis C infection and the possible long-term implications of the disease.
■ risk activities that the patient may have been involved in which have put them at risk of hepatitis C infection. Some attempt should be made to establish the date of the last risk activity (so that the 3 months antibody production ‘window period’ is taken into account).
■ information about risk reduction and harm minimisation appropriate to the patient’s circumstances.
■ the implications of a positive or negative result for the individual and his/her family, e.g. the possible effect on relationships and the possible need for sexual partners to be tested. Establishing what support network the individual may have and giving information about national/local organisations that provide support.
■ the testing procedures, including what the test involves, where it will be done, how long before the results come back, who will give the results and how, and what the results will mean; and the possible need for referral to a specialist for further investigations.
■ treatment, when it is offered, its nature, possible duration, and likely success rate.
■ informed consent.
Discussion before undertaking source patient testing after an accidental occupational exposure to blood may not need to cover all these matters unless the patient has independent risk factors for hepatitis C infection.
Results should be given in person wherever possible.
■ Where antibody test results are negative, patients should, where appropriate, be advised on ways of avoiding infection in the future.
■ Repeat testing is recommended if the patient is believed to have been recently exposed to the virus, since HCV antibodies can take up to 3 months to develop.
■ A positive antibody test should be confirmed by testing a second sample. It is important that the patient clearly understands the result, and that further tests are required to establish whether there is current hepatitis C infection and identify the extent of any disease. These tests may be carried out in primary or secondary care according to local arrangements. The patient should usually
be referred to the appropriate specialist with an interest in hepatitis C. Local referral protocols may vary.
■ The patient may need support to come to terms with a positive test result and potential future implications. Referring practitioners should consider providing such support during the period that patients wait to see a specialist or exploring whether such support is available from the specialist department before the first appointment.
■ Reiterate natural history of HCV.
■ Patients who are HCV positive should be advised not to donate blood or carry an organ donor card.
■ If an HCV RNA detection test is done before referral to a specialist and is positive (indicating current infection has been diagnosed), patients should be advised:
– To stop or reduce alcohol consumption. Continued alcohol consumption is associated with more rapid progression of liver disease. Patients may need to be referred for specialist alcohol support and counselling;
– Not to share any injecting equipment (where appropriate);
– To avoid sharing razors or toothbrushes, and to cover cuts and skin lesions with waterproof dressings;
– To consider that, although uncommon, sexual transmission can occur, and that the use of condoms will minimise this risk;
– To consider advising any regular sexual partners that they may wish to consider being tested for hepatitis C.
■ Where a mother is newly diagnosed with hepatitis C infection, consideration should be given to testing any of her children who may have been born subsequent to her exposure to hepatitis C. Appropriate timings for testing should be included (explanation of presence of maternal antibodies, for example).