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. 2018 Jun;146(8):1026-1035.
doi: 10.1017/S0950268818000870. Epub 2018 Apr 17.

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

S Parry  1 , N Bundle  2 , S Ullah  1 , G R Foster  3 , K Ahmad  4 , C Y W Tong  5 , S Balasegaram  6 , C Orkin  1
Affiliations

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

S Parry et al. Epidemiol Infect. 2018 Jun.

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 ⩾1 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 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.

Keywords: Blood-borne virus seroprevalence; blood-borne virus testing; emergency department; hepatitis C; infectious disease epidemiology.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
A flowchart of testing uptake and seroprevalence.
See this image and copyright information in PMC

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