The authors compared the characteristics and behaviours of people with HIV living in Ireland with those in Australia.1 The data were collected between June and December 2005 and the participants were asked about tobacco, alcohol and other drug use. The average age of the respondents in Ireland was 36.2 years, and in Australia 45.3 years. Sixty-seven per cent of the study group in Ireland were men, while 98% of those in Australia were men. Forty-seven per cent of the participants in Ireland were Irish and 42% were African. Two thirds of the participants in Australia were Australian and 16% were New Zealanders. Forty-two per cent of participants in Ireland reported using recreational drugs at some point in their life; seven respondents reported ever injecting, and four reported a history of drug dependence. Fifty-four per cent reported smoking tobacco at some point in their life. Seventy-two per cent drank alcohol at some point in their life, of whom 9% reported a history of alcohol dependence.

 

Ninety-six of 183 clients attending methadone treatment at the Drug Treatment Centre Board in Dublin were randomly selected to complete a 12-item questionnaire, and to provide nasal swabs to be tested for meticillin resitant Staphylococcus aureus (MRSA) and meticillin sensitive Staphylococcus aureus (MSSA) and blood samples for viral analysis.2 

 

Of the 96 nasal swab specimens submitted for culture and identification, 3.1% grew MRSA and 25% grew MSSA. The serological analysis revealed that 73% of the clients were hepatitis C positive and 12% were HIV positive.

 

Seventy three per cent of the sample were men. Twenty-seven per cent of the clients had been in prison in the year prior to the survey and 86% had been in prison at least once in their life. One quarter had been homeless at some stage in the preceding 12 months and 27% lived alone.

 

Seventeen per cent had snorted cocaine in the year prior to the survey and 24% had injected it. Forty- eight per cent had injected heroin in the 12 months prior to the survey, and 53% had injected either heroin or cocaine. All injectors had attended needle-exchange services at least once in the 12 months prior to data collection; only 7% had shared needles, while 18% had shared other injecting equipment. Twenty-eight per cent reported at least one soft-tissue abscess in the past year, 71% had had one or more courses of antibiotics, and 40% had had at least one hospital admission. 

 

As the prevalence of MRSA was low and the sample size very small, it was not possible to identify factors associated with MRSA carriage among those in methadone treatment. The prevalence of MRSA in the opiate-dependent population in Dublin is lower than that in Brighton (49%) and Vancouver (19%) but higher than that in Italy (1.1%). 

 

This study examined all referrals made to an urban tertiary care liver centre for hepatitis C virus (HCV) management, tracked subsequent progress and identified the dropout rate at the different stages.3 The authors completed a cross-sectional retrospective review to examine HCV referrals received between 2000 and 2007. The demographic, clinical and treatment data were extracted from medical charts and the hospital information system.

 

A total of 588 individuals and 742 cases were referred for management of their hepatitis C. Sixty-seven per cent of referrals were men and the average age was 33.3 years. Three quarters (74%) of cases were injecting drug users. Eighty-three per cent of cases were Irish. Fifty-seven per cent of cases were referred by their general practitioner. Other sources of referral were hospital, drug treatment centres, prisons and asylum centres. Of the 742 referrals received, 141 (19%) failed to attend their initial appointment, 180 (24%) dropped out from early outpatient management, 29 (4%) failed to attend for liver biopsy and 81 (11%) did not attend subsequent outpatient follow-up. In total, 451 (61%) dropouts occurred. In those treated, a sustained viral response rate (successful treatment rate) of 74% was observed. The number and proportion of patients who experienced viral clearance varied with genotype, specifically, genotype 1 18/30 (60%); genotype 2 4/5 (80%); genotype 3 40/49 (82%). Those with a history of injection drug use were more likely to drop out immediately after the referral, dropout from early outpatient management and dropout over entire span of disease management than their non-injecting counterparts. Men were more likely (P<0.05) to drop out of disease management than women. Eight individuals died during the study period.

 

The authors report that an ‘exceptionally high rate of dropout exists’ among those attending services to monitor and manage hepatitis C in injecting drug users, particularly in the early stages of service delivery. The study findings have led to the development of innovative approaches helping to optimize hepatitis C management in this population, such as texting reminders and using a change model to improve engagement and compliance with behaviour and treatment.

 

This study measured the knowledge of and attitudes towards hepatitis C among 560 nurses working in general practice, public health and addiction, and identified the source of their knowledge.4 The researchers completed a cross-sectional survey in 2006 with the nurses in the three categories of primary care through a postal questionnaire in one region of Ireland. The questionnaire contained five sections: demographic, work profile, knowledge, attitude and education. The questions were validated and pilot tested. The total number of primary care nurses working in the region was 981 and 560 (57%) completed a questionnaire. The response rates varied by type of nursing specialism: general practice was 57% (126), public health 55% (385) and addiction services 83% (49). The attitudes of the nurses towards hepatitis C are not presented in this paper.

 

Almost all (98%) of the nurses were female, and their average age was 43 years. Nurses in the addiction services were younger than those in general practice or in public health services. The nurses’ qualifications ranged from certificate (25%) to post graduate degree (4%) level. Fifty-five per cent were qualified to diploma or higher diploma level and 15% were qualified to at least degree level. Nurses in the addiction and in the public health services had higher qualifications than those in general practice. Nurses working in the public health service had longer service than those in addiction or general practice. Addiction nurses were more likely to work full time.

 

Eighteen per cent had a personal friend or relative who had hepatitis C. Thirty-nine per cent of respondents reported having professional contact with people with hepatitis C. As expected, nurses in addiction services had more professional dealings with people with hepatitis C (96%) compared to nurses in public health (30%) or in general practice (44%). According to the authors, 90% of addiction service nurses provided information on the dangers of alcohol, the benefits of hepatitis A and B vaccination, dietary intake and transmission of the virus, while only 30% of nurses in public health provided advice on the dangers of alcohol, and 11% of the same cohort on the benefits of hepatitis vaccination. The advice provided by practice nurses is not reported. 

 

Only 22% of nurses had received formal training on hepatitis C. Not surprisingly, a higher proportion (86%) of nurses working in the addiction services received training on hepatitis C, compared to the proportions working in public health (13%) or general practice (16%). Ninety-six per cent of nurses working in the addiction services reported that they were well informed about hepatitis C, while only 20% of practices nurses and 21% of public health nurses reported the same. The respondents were asked to identify 21 statements about hepatitis C as true or false. Though the nurses working in addiction services had good knowledge about hepatitis C, there were four areas where 25% or more provided an incorrect answer, and these were:

The level of knowledge among the public health and practice nurses was less than desirable, with at least 12 areas where 25% of the nurses provided an incorrect answer. Four of the areas were those cited above and the other eight areas were:

The authors calculated mean knowledge-level scores for each group of nurses; the mean score for addiction nurses was 22.5, for nurses working in public health 16 and for practice nurses 16.9. The overall mean score was 16.7. Nurses were most likely to have better knowledge about hepatitis C if they were younger, educated to degree level or above, attended a formal training course, personally knew someone with hepatitis C, had professional contact with patients with hepatitis C, or considered that they themselves were well-informed about hepatitis C.

 

Nurses working in public health services and general practice require formal training in hepatitis C care and management. Nurses in the addiction services need to update their knowledge in four areas.

 

1. O'Connor MB, O'Connor C, Saunders SA, Sheehan C, Murphy E, Horgan M et al. (2010) Substance use among HIV patients. Irish Journal of Medical Science, 179(3): 467–468.

2. Somers CJ, Bridgeman J and Keenan E (2010) Nasal carriage prevalence of meticillin resitant (MRSA) and meticillin sensitive (MSSA) Staphylococcus aureus for subjects attending a Dublin methadone clinic. Journal of Infection, 60(6): 494–496.

3. Lowry DJ, Ryan JD, Ullah N, Barry T and Crowe J (2011) Hepatitis C management: the challenge of dropout associated with male sex and injection drug use. European Journal of Gastroenterology & Hepatology, 23(1): 32–40.

4. Frazer K, Glacken M, Coughlan B, Staines A and Daly L (2011) Hepatitis C virus in primary care: survey of nurses’ attitudes to caring. Journal of Advanced Nursing, 67(3): 598–608.