Download 7. Referral pathways and relevant pathways of care

APPENDIX 8 D:\582727889.doc
Cornwall Drug & Alcohol Services
Integrated Care Pathway
Blood Borne Virus (BBV) Testing and HAV/HBV Immunisation
1. Description
This service is provided by the Primary Care Viral Hepatitis Nurse Specialists (2), based within specialist substance
misuse services or accessed via the GU Clinic or any GP. This ICP describes those interventions that are provided for
Cornwall and the Isles of Scilly residents and includes:
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Pre and Post test discussion
Testing for BBV – HCV, HBV and HIV
Appropriate information leaflets
Harm reduction advice
Appropriate immunisation for HAV /HBV
Referral for HCV/HBV treatment if required
Testing to be offered annually or more frequently if indicated
Referral To GU for HIV assessment and treatment If indicated
Advice for carers, partners and wider community
2. Access & referral
Clients accessing Cornwall Substance Misuse Services may access this service via any local alcohol and drug
services or via the Primary Care Viral Hepatitis Nurse Specialists directly. This includes All Tier 2 or 3 services. Drug
and alcohol services in Cornwall are available through GP surgeries or team bases in Liskeard, Bodmin, Truro, St
Austell, Redruth, Newquay and Penzance.
Referrals can be made by telephone, email or in person
Waiting time
Appointments will be offered within 21 days of referral being received.
3. Treatment aims and objectives
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To offer advice and information about the transmission and risks of Hepatitis A, B and C
To offer Pre and post test discussion where appropriate
To take blood for testing
To offer the full course of HAV / HBV vaccinations / boosters / blood tests where appropriate
To ensure that anybody undertaking this service is fully aware of any testing implications
To offer a seamless link into Hepatitis C treatment services where appropriate
To facilitate treatment completion by care co-ordinating drug treatment clients through hepatitis C treatment and
through delivery of treatment through primary care.
To offer annual testing and more frequent testing where indicated for all clients in structured drug treatment.
Target: 95% of all those eligible complete vaccination programme for Hepatitis B and receive testing for hepatitis C.
4. Who is the service for? (client group served)
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Substance misusers who report current or historic risk of contracting hepatitis A, B or C, HIV
Advice and signposting for carers, partners, family members
Eligibility
CIOS residents who report current or historic risk of contracting hepatitis A, B or C, HIV
Priority Groups
Pregnant substance misusers. Advice From Twinrix manufacturer and DoH differs slightly in emphasis:
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APPENDIX 8 D:\582727889.doc
Pregnancy Data on outcomes of a limited number of pregnancies in vaccinated women do not indicate any adverse
effects of Twinrix Adult on pregnancy or on the health of the fetus/newborn child. While it is not expected that
recombinant hepatitis B virus surface antigen would have adverse effects on pregnancies or the fetus it is
recommended that vaccination should be delayed until after delivery unless there is an urgent need to protect the
mother against hepatitis B infection. (Summary of Product Characteristics – GlaxoSmithKline UK – 24.3.2010)
Lactation It is unknown whether Twinrix Adult is excreted in human breast milk. The excretion of Twinrix Adult in milk
has not been studied in animals. A decision on whether to continue/discontinue breast-feeding or to
continue/discontinue therapy with Twinrix Adult should be made taking into account the benefit of breast-feeding to the
child and the benefit of Twinrix Adult therapy to the woman. (Summary of Product Characteristics – GlaxoSmithKline
UK – 24.3.2010)
Pregnancy and Breast Feeding ‘Immunisation should not be withheld from a pregnant woman if she is in a high risk
category. There is no evidence of risk from vaccinating pregnant women or those who are breast-feeding with
inactivated viral or bacterial vaccines or toxoids. Since hepatitis B is an inactivated vaccine, the risks to the foetus are
likely to be negligible, and it should be given where there is a definite risk of infection’ (DOH 2007, ‘The Green Book’
p179)
Exclusions/Contraindications
Hypersensitivity to the active substances or to any of the excipients or neomycin.
Hypersensitivity after previous administration of hepatitis A and/or hepatitis B vaccines.
The administration of Twinrix Adult should be postponed in subjects suffering from acute severe febrile illness.
(Summary of Product Characteristics – GlaxoSmithKline UK – 24.3.2010)
5. Duration
This service is offered for the duration of the testing and where appropriate immunisation period
Immunisation is offered as follows:
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Combined HAV/HBV vaccine (Twinrix)
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Accelerated schedule: 0, 7, 21 days with booster ideally at 12 months ( DOH, 2007 ‘The Green Book’)
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Routine Schedule: 0, 1 month, 6 months with or without booster dose (DOH, 2007 ‘The Green Book’)
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Alternative accelerated schedule: 0, 1 month, 2 months with booster at 12 months ( DOH, 2007 ‘The Green
Book’)
6. Cost
This service is free to service users.
£100,000 of the contract price is dedicated to this service area.
7. Referral pathways and relevant pathways of care
Immunisations, test dates and results will be shared with the Care Coordinator and should be recorded within case
notes and NDTMS.
8. Description of the treatment process/phases
The Testing process will be offered to clients as indicated by their reported level of risk behaviour.
9. Aftercare & Case Closure
Refer back to care of GP and Substance Misuse Service as appropriate.
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