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In response to Dr Lloyd's decision to commence earlier anti-HCV screening, Professor Cash suggested that the evaluation of second-generation tests might be modified to accommodate the screening programme in Newcastle.

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Dr Lloyd wrote to Dr Gunson asking "whether there was in a fact a strategy which involved delaying the introduction of tests whilst awaiting central funding for this test".

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Dr Jean Harrison, Director of the North East Thames RTC, declined to participate in Professor Allain's proposed study to test for anti-HCV in samples from blood transfusion recipients.

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Professor Allain disagreed with Dr Harrison's analysis of the ethical position in respect of her refusal to participate in his proposed study to test for anti-HCV in samples from blood transfusion recipients. Professor Allain asked if Dr Harrison's ethical reasoning was true, why did she then not start screening all her donors now? He stated that if she did not, she was just as much open to litigation until 1 September 1991, whether she entered the study or not.

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Dr Harrison replied to Dr Allain stating that she did think there was exposure to possible litigation but at that time Brentwood RTC did not have the funding, equipment or staff training to commence anti-HCV testing immediately.

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A letter from Dr Gunson to Professor Cash stated, in relation to anti-HCV testing, that for the UK it was "important that the SNBTS and the NBTS act in close collaboration since I can foresee difficulties if one of us introduced the test unilaterally".

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Dr Gunson wrote to RTC directors in England and Wales informing them the Department of Health had agreed that routine anti-HCV testing could be put into operation, saying that he sought to ensure testing started simultaneously in all RTCs, and asking them to respond with the "earliest date that you could commence testing".

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Dr Lloyd argued that although the evaluation of second-generation test kits had not yet been completed, UK screening should now start "come what may".

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400 anti-HCV testing samples per day were being processed and the test was running "consistently with the manufacturer's expectations" but it was a "considerable drain on resources."

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In the National Blood Authority litigation, Dr Gunson gave evidence in relation to false positives in results and decisions made by the Department of Health and comparisons with the USA with regards to the decision to test for Hepatitis C and its accuracy (FDA decisions also).

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Dr John Barbara gave oral evidence in the Hepatitis C litigation about the medical profession's perception of Hepatitis C and HIV in the early 1990s, as well as the sensitivity of tests for HCV and HIV going to the root of the problem of pre-transfusions.

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Marcela Contreras and John Barbara wrote to Dr Harvey Alter, stating it was unethical to delay anti-HCV screening pending the US study of post-transfusion hepatitis infections, and questioned the causal association between transfusion and cases of cirrhosis.

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Dr Marcela Contreras, director of North London Blood Transfusion Centre, wrote to Dr Gunson regarding funding for the introduction of anti-HCV screening of blood donations in 1990 and admitted that she did not consider anti-HCV testing to be a top priority.

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At a meeting of the North London Blood Transfusion Centre, discussions included results of the US studies, significance of positive anti-HCV test results, equipment and kits, and options to have positive/borderline samples sent for further testing.

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Dr Lane sent Dr Rejman a paper for discussion at the next ACVSB meeting which concluded that the procedures to minimise hepatitis virus transmissions continued to present problems, giving rise to a need to address the requirements for a marker to identify non-A non-B Hepatitis (HCV) carrier status.

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Professor Cash wrote to Dr Gunson, stating it was important for the SNBTS to look at the prevalence of the Chiron test positives in the donor community, noting 5000 donations were to be selected from those with ALT data already identified.

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Dr Lloyd, NBTS, wrote to Mr Garland, director of management services of the Northern Regional Health Authority in relation to non-A non-B Hepatitis, noting the fairly rapid mounting pressure for the test to be introduced in the UK, likely without funding by the Department.

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Marcela Contreras wrote to Dr Gunson in relation to factors to consider before placing orders for routine donor screening with the new anti-HCV test, including whether "lookback" would be required, the expense of obtaining and processing confirmatory samples and the data from the preliminary studies in Europe requiring extension.

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Professor Cash wrote to Dr Gunson in relation to the Chiron Test, stating their Service would not move unilaterally unless instructed to do so by SHHD, and he noted that SNBTS would only be able to discuss contracts for supply (of the HCV test) when instructed to do so.

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Professor Cash wrote to colleagues by way of update, indicating NANB (Chiron) Testing soon.

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