Guidance for the prevention, testing, treatment and management of hepatitis C in primary care.

1. Hepatitis C infection is an under-diagnosed (five out of every six people infected are undiagnosed) and under-treated important cause of morbidity and mortality. 2. Hepatitis C is a common and potentially curable disease, but only 1 to 2% of infected people are currently receiving National Institute of Clinical Excellence (NICE) recommended therapy. 3. Every general practitioner is likely to have between 8 to 18 infected individuals per GP, based on an average list size of 1,800 and, partly depending upon local population demographics. Many of these patients may not be diagnosed and knowledge about HCV in population and primary care remains low but improving. 4. Prevalence of the hepatitis C virus (HCV) is estimated to be between 0.4 to 1% of the United Kingdom (UK) population, equating to be between 250,000 to 600,000 sufferers. Worldwide there are an estimated 170 million people, about 3% of the world’s population, who are chronically infected with HCV. 5. HCV is a blood-borne ribonucleic acid (RNA) virus that exists as a number of different strains (genotypes) and an important cause of liver disease. The effects of the infection vary from one individual to the next. Some people will remain symptom free, some will develop cirrhosis and others will develop liver failure or hepatocellular (primary liver) cancer

Guidance for the use of methadone for the treatment of opioid dependence in primary care.

• Methadone is an effective evidence based medication used for the treatment of opioid dependence. • It is most effective when used as a maintenance agent at optimal dosing. • Its primary function is to reduce (and eventually replace) illicit opioid use and in so doing, reduce harm and improve the health and psychological well-being of the patient