P63 ‘Get tested LeEDs’: testing for hepatitis B, hepatitis C and HIV in an Urban emergency department via notional consent

Abstract

<h3>Background</h3> Both Hepatitis B and C are underdiagnosed and Public Health England (PHE) estimates there are around 143,000 people living with Hepatitis C (HCV) in the UK, with around two thirds of these undiagnosed. In inner cities, the frequency of chronic Hepatitis B (HBV) infection is increasing because of migration from high prevalence areas. With this in mind and NHS England’s plan to eliminate Hepatitis C within the decade, increased testing for the viruses is vital. ‘Get Tested LeEDs’ implemented blood borne virus (BBV) testing in the Emergency Department (ED) from October 2018 to March 2020. <h3>Method</h3> Patients attending the ED aged between 16 and 65 and having U&amp;Es taken were offered BBV testing via notional consent (posters and leaflets). HIV, Hepatitis B and Hepatitis C testing was done unless the patient declined or did not have capacity. Viral hepatitis testing included HCV antibody (HCV Ab) and HBV surface antigen (HBsAg). Positive HCV Ab had reflexed HCV RNA and confirmed HBsAg positive had a full serology panel. Positive results were electronically reported to specialist nurses and results given to patients face to face where possible. <h3>Results (Data from Oct 2018 to July 2019)</h3> There was a total of 112,479 attendances, with 28,178 (25.1%) having U&amp;Es taken. Of these, 16,053 (57%) had BBV testing. There were 345 HCV Ab positive cases (2.1%) of which 156 (1%) were HCV RNA positive (45% of HCV Ab positive were HCV RNA positive). Of the HCV RNA positive cases, 76 were new diagnoses, 72 had been lost to follow up and 8 were currently in care. Of the 148 patients with a new diagnosis or lost to follow up, 51 patients so far (34%) have been commenced on treatment for Hepatitis C. There were also 73 HBsAg positive cases of which 35 were new diagnoses, 34 were currently in care and 4 had been lost to follow up. 24 out of 35 patients with a new diagnosis (69%) were subsequently reviewed in a specialist clinic. <h3>Conclusion</h3> The ‘Get Tested LeEDs’ initiative has shown that testing for BBV in the ED, alongside the traditional settings (hostels, prisons and substance misuse clinics), offers additional access to this cohort of the population. However, maintaining contact, adherence to regular follow up and treatment is often difficult in this population. Nevertheless, with recent advances in the treatment of viral hepatitis, every opportunity needs to be taken to identify and treat.