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Opt-out HIV/HBV/HCV testing for patients attending emergency departments identifies significant number of new infections
Michael Carter, 2016-03-22 10:00:00
A pilot study
involving nine UK emergency departments has shown that routine, opt-out testing
for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at UK can identify
a significant number of previously undiagnosed infections. The results are
published in HIV Medicine. The
weeklong study involved emergency departments across the UK. Adult patients
having blood tests as part of their care were offered opt-out screening for
HIV/HBV/HCV. Over a quarter of patients consented to be tested and 3% of these
individuals were identified as being infected with a blood-borne virus (BBV),
and 45% of these infections were new diagnoses.
“We identified a
high number of newly diagnosed viral hepatitis case, especially hepatitis C, in
addition to the HIV diagnoses,” comment the authors. “Had these patients only
been tested for HIV during the campaign week (as per UK guidance), and not for
HCV or HBV, these viral hepatitis diagnoses may well have been missed.”
In the UK,
blood-borne viruses, especially HIV and HCV, are often diagnosed late.
Guidelines recommend routine, opt-out, HIV testing for all patients accessing
primary care in settings where local HIV prevalence exceeds 0.2%. Research
conducted in other countries has shown that hospital emergency (or casualty)
departments can be feasible settings for routine screening for blood-borne
viruses. A team of investigators therefore designed a pilot study to determine
the prevalence of HIV, HBV and HCV among patients attending accessing emergency
care in the UK.
The “Going Viral”
campaign was conducted for one week between 13-19 October 2014 and involved
nine hospital emergency departments in UK areas with high HIV prevalence: five
of the participating hospital emergency departments were in London, two were in
Essex, one was in Leeds and one was in Glasgow.
All adult patients
having blood tests as part of their care were offered opt-out testing for
blood-borne viruses. Demographic data were obtained. Patients newly diagnosed
with a blood-borne virus were linked to care.
campaign, 7807 patients attended the nine emergency departments and had blood
tests. Uptake of testing for blood-borne viruses was 27% (2118), but this
varied between participating hospitals (10%-60%). Overall, 52% of those testing
were women, the median age was 47 years and 42% identified as white.
A total of 71
blood-borne viral infections were detected, and 32 of these were new diagnoses.
There were 39 HCV
diagnoses (15 new), 15 HBV diagnoses (eleven new) and 17 HIV diagnoses (six
new). One person was newly diagnosed with HIV and HCV co-infection.
Prevalence of the
three infections varied: 1.84% for HCV (newly diagnosed 0.71%), 0.71% for HBV (0.51%
newly diagnosed) and 0.8% for HIV (0.52% newly diagnosed).
25-54 years had the highest prevalence: HCV, 2.46% (1.18% newly diagnosed),
HIV, 1.36% (0.5% newly diagnosed) and HBV, 1.09% (0.5 newly diagnosed).
assumed that each test for a blood-borne virus cost £7. This meant that it cost
£988 per new HCV diagnosis; each new HBV diagnosis cost £1351 and each new HIV
diagnosis cost £2478.
Most of the new
diagnoses would have been missed if only patients presenting with symptoms
suggestive of possible HIV infection were tested.
were able to contact 23 of the 32 individuals (71%) with a newly diagnosed
infection; two-thirds of these patients attended for a follow-up appointment
and 59% remained in care after six months. Ten patients with a previously
diagnosed infection but lost to follow-up were also identified. The
investigators were able to contact six of these patients, five were linked to
care and two were retained in care after six months.
“These pilot data
on BBV need to be corroborated with longer term data and much more detailed
analysis of feasibility, sustainability and acceptability to staff and patients
in a longer study,” conclude the authors. “However, this snapshot of BBV
testing in some UK emergency departments suggests that perhaps a year-round BBV
screening policy in certain age groups and geographical locations may diagnose
many more new viral hepatitis as well as new HIV infections.”