Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department-uncovering the iceberg?

S. Parry, N. Bundle, S. Ullah, G. R. Foster, K. Ahmad, C. Y.W. Tong, Uthayasoori Balasegaram, C. Orkin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The 'Going Viral' campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus -3/41 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 <350, APRI (AST-to-Platelet Ratio Index) >1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.

Original languageEnglish
Pages (from-to)1026-1035
Number of pages10
JournalEpidemiology and Infection
Volume146
Issue number8
DOIs
Publication statusPublished - 1 Jun 2018

Bibliographical note

Publisher Copyright:
© 2018 Cambridge University Press.

Keywords

  • Blood-borne virus seroprevalence
  • blood-borne virus testing
  • emergency department
  • hepatitis C
  • infectious disease epidemiology

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