Diagnostic and Treatment Services

Lead: Dr Neil McDougall, Consultant Gastroenterologist and Hepatologist, Royal Victoria hospital

Work stream aim:

To promote timely diagnosis of HBV & HCV infection in NI (particularly in high risk groups), and to facilitate equitable access to high quality treatment of diagnosed HBV & HCV infections through the regional hepatology unit in RVH.


  • To utilize the HCV register to track the progress of all newly diagnosed cases of HCV infection in NI and to improve follow-up of HCV cases not referred for treatment or those lost to follow-up; 
  • Increase the links with the surveillance workgroup to take a much more proactive attitude towards the PCR positive patients who are not referred to specialist hepatology services. 
  • To agree and disseminate a comprehensive care pathway for the management of individuals diagnosed with HBV and HCV infection in NI, which includes pre-treatment assessment and work-up in a peripheral acute centre (if appropriate) followed by referral to the regional hepatology unit where all HBV and HCV treatments will be undertaken;
  • To streamline referral pathways for healthcare professionals who identify HBV and HCV positive cases, allowing rapid access to specialist advice (possibly using the hepatology nurse specialist team as a first point of contact)
  • To deliver all treatment of HBV and HCV infection in NI through the regional hepatology unit, using treatment guidelines based on NICE recommendations;
  • To augment the current regional hepatology service by provision of a second specialist hepatology nurse in the regional unit and to use the nurse specialist team to enhance liaison with other health/social care services requiring specialist input;
  • To enhance existing long term follow-up arrangements for HBV and HCV cases in NI (e.g. hepatoma surveillance);
  • To liaise with NI Prison Service and with the drugs/addiction work-stream of the Hepatitis B and C MCN, in order to improve uptake of testing and assessment/treatment of HBV and HCV positive cases identified within this high risk population;
  • To undertake quality assurance of HBV and HCV diagnosis and management in NI through regular audit and comparison with national standards/other comparable regions in the UK (e.g. South West Hepatology Group, Peninsular Region, England);
  • Pending the issue of anticipated DHSSPS guidance, to review and action issues relating to HBV and HCV diagnosis and management in the occupational healthcare setting;
  • To obtain feedback on HBV and HCV services from patients/clients/service users, and to use this feedback to enhance diagnostic and treatment services provided;
  • To develop links with the surveillance workgroup, PHA and Regional Virus Laboratory and take a much more proactive attitude towards all chronic HBV patients in NI who are not referred to specialist hepatology services. 
  • To work closely with Maternity Services to improve the referral pathways, assessment and management of patients diagnosed with chronic HBV during pregnancy (including annual audit of NI data)