BMC Public Health 2006, 6:3 http://www.biomedcentral.com/1471-2458/6/3 Table 3: Eligibility for anti-viral treatment of patients with Hepatitis C and reasons for patient refusal Question Which of the following criteria do you consider in determining eligibility for treatment? Choices Percentage of units saying yes What were the main reasons for patients' ineligibility? What are main reasons for patient refusal of treatment? Age Gender Genotype Severity of hepatitis Co-morbidities 73% current/future drug/alcohol use Ongoing drug use Ongoing alcohol use Psychiatric disorder Other medical co-morbidities Cardiovascular disease Concern over side effects 49 Inconvenient to start treatment -work pressures 37 Refusal to modify chaotic lifestyle 30 Lack of belief of efficacy 15 61 8 29 93 95 62 21 11 3 2 Default rates reported for the initial out-patient appoint- ment were high, with the median per CSP being 10–24%. There was no association between the default rate and size of unit (p = 0.19). Patient management Co-ordinated management strategies for patients with HCV were reported by 45%% (44) of CSPs, with formal collaboration between CSP and other services. The most common formal links were between the CSP and Drug and Alcohol Teams (n = 37), GUM services (n = 30), pris- ons (n = 22), primary care (n = 20) and homeless units (n = 14). Other links included asylum seekers (2), other medical specialities (5) and a renal dialysis unit (1). 57% of CSPs had a hospital based multidisciplinary team (MDT) that met regularly to discuss the management of HCV patients. The composition varied but most com- monly included the consultant from the lead clinical spe- cialty, specialist nurse, pathologist, radiologist and DAT representative. Only three MDTs had a patient representa- tive. The larger units led by Hepatologists and ID Physicians had more access to specialist nurses, who played a key role in starting treatment and in monitoring patients. Drug treatment 10–24% (median) of new patients was considered eligible for anti-viral drug treatment. Table 3 shows the factors used to determine eligibility. Over 90% of responding CSPs used severity of hepatitis, more than 60% of respondents used age, and 90% used co-morbidity. The most important single reason reported for ineligibility, by over 60% of CSPs, was ongoing illicit drug use. The most common reason given for why patients refused treatment was concern over side effects (see Table 3). 24% of CSPs reported that over 90% of the eligible patients were treated, with 50% reporting that over 75% of eligible patients were treated (median range 50%– 74%). The majority were not treated in clinical trials. 35% of CSPs offered treatment to patients with mild hep- atitis -of these 95% offered treatment to patients with symptoms and 49% to patients who were asymptomatic. Virtually all of the respondents definitely offered treat- ment to patients with moderate or severe hepatitis /cirrho- sis (Child-Pugh A), 48% (38) (with 9% (7) "maybe treat") also treated those with Child-Pugh B, and 14% (11) treated patients with Child Pugh C cirrhosis. 16% (and 8% "maybe") offered antiviral treatment for those await- ing transplantation. In the majority of cases there was no link between the CSP treating HCV related end-stage liver disease with anti-virals and whether they were transplant centres or had close collaboration with transplant centres. (Child Pugh is a clinical score to evaluate prognosis in cir- rhosis using bilirubin, albumin, INR, ascites and enceph- alopathy which are awarded points depending on values., Page 4 of 9 (page number not for citation purposes)