Abstract
Therapies that halt progression of chronic hepatitis B virus (HBV) and achieve a cure for chronic hepatitis C virus (HCV) have encouraged development of innovative strategies to diagnose and link patients to care. We describe the prevalence and risk factors for HBV and HCV infections and use of an opt-out hepatitis testing and integrated linkage to care pathway in a London Emergency Department (ED). ED patients aged ≥16 years having routine blood tests from 15 February-28 March 2016 were tested for hepatitis, unless opted out. Hepatitis B surface antigen (HBsAg) and hepatitis C antibody tests (HCV-Ab, including a confirmatory hepatitis C antigen test (HCV-Ag)) were pre-selected on electronic blood test requests. Linkage to care (attending one clinic appointment) was offered to HBsAg and HCV-Ag patients (new or known-disengaged with care diagnoses). Weighted prevalence estimates and risk factors for seropositivity adjusted by demographics and survey weights were calculated using logistic regression. Hepatitis testing uptake was 56% (3,290/5,865). Overall, 26 HBsAg (10 new diagnoses) and 63 HCV-Ab patients were identified of which 32 were HCV-Ag positive (10 new diagnoses). Weighted seroprevalence of HBsAg was 0.50% (95% CI 0.3–0.8%); HCV-Ab 2.0% (95% CI 1.5–2.7%) and HCV-Ag 1.2% (95% CI 0.8–1.7%). Risk factors for infection were being male (HBsAg: aOR 4.1, 95% CI 1.5–11.3), of non-White British ethnicity (HBsAg: aOR>11) or being homeless (HCV-Ag: aOR 18.9, 95% CI 6.9–51.4). We achieved a high linkage to care uptake for HBsAg (93%) and HCV-Ag (78%) among patients who were contacted and required linkage. A pre-selected hepatitis testing ordering system facilitated a high testing uptake. New and disengaged with care diagnoses and a high HCV prevalence were identified demonstrating the potential to identify and link patients to care in this setting. Strategies connecting clinical care with community outreach services are key for improving patient linkage to care.
Highlights
Hepatitis B (HBV) and C (HCV) virus infections continue to cause considerable morbidity and mortality worldwide and within the UK
We conclude that an adaptable electronic testing ordering system and the adoption of an optout testing strategy are key components to assist viral hepatitis testing uptake in an Emergency Department (ED)
During the six week pilot study, 20 new viral hepatitis diagnoses were detected which may have been otherwise missed providing a benefit to the patient through earlier diagnosis and improved clinical outcome and to public health by reducing onward transmission
Summary
Hepatitis B (HBV) and C (HCV) virus infections continue to cause considerable morbidity and mortality worldwide and within the UK. In the UK, an estimated 180,000 and 214,000 people have chronic HBV and HCV infection, respectively [1, 2]. Recent developments in HCV therapy offering clearance of infection and effective treatments to reduce disease progression of HBV have driven an increasing demand to test, diagnose and link patients into appropriate treatment and care services [12, 13]. This would contribute to identifying undiagnosed patients, improving clinical outcomes and reducing onward transmission
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