Introduction Hepatitis B (HBV) and C (HCV) are major public health problems in areas such as London. Some 50% of those with HCV in UK are undiagnosed. Emergency Departments (ED) provide healthcare to those with no other access. A six week pilot project in Guy’s and St Thomas Hospital ED evaluated the feasibility of screening for HCV and HBV in ED and success at linking to care.
Method Patients having blood tests in ED were offered HBV surface antigen (HBsAg) and HCV antibody (anti-HCV) testing between 15 February 2016 and 28 March 2016. Linkage to care (attending one outpatient appointment) via a one stop clinic for new diagnoses or known but disengaged patients was coordinated by a project team. The proportion attending ED, requiring a blood test and tested for HBV and/or HCV is described by demographics (age, sex, ethnic group, no fixed abode and area of deprivation). Seroprevalence estimates are calculated and weighted by age, sex and ethnicity distributions of the blood tested population with 95% confidence intervals (CI). We use logistic regression to calculate odds ratios (aOR) to identify risk factors for positivity among those tested, adjusted for demographic variables.
Results 13 035 individuals attended ED, 5813 individuals received a blood test of whom 3262 (56%) had a HBsAg and/or HCV antibody test. 25 patients were diagnosed with HBV (adjusted prevalence: 0.46%, 95% CI: 0.29%–0.71%). Most were male (72%), aged 30 to 49 years (52%) or of black ethnicity (44%). Of the 58 anti-HCV positive patients, 32 were also Hepatitis C antigen positive (adjusted prevalence: 1.18%, 95% CI: 0.80%–1.74%). Most were male (75%), aged 30 to 69 years (78%) or of white ethnicity (75%). Having no fixed abode was associated with being positive for HCV antigen (aOR: 7.70, 95% CI: 0.17–3.50, p<0.01). We contacted 17 chronic HBV patients (68%). 10 were new diagnoses and 7 were known cases (3 were already engaged in care). 14 of those contacted attended one appointment and 12 were still in care at one year. 21 chronic HCV patients were contactable (65%), (11 were new diagnoses, 10 known diagnoses). 17 patients needed linkage to care (one already engaged in care, one moved to another hospital, one was end of life (unrelated to HCV) and one was a tourist). 10 attended and 9 were still in care at one year.
Conclusion Opt out ED screening had high uptake with a high prevalence for both HBV and HCV. A simplified care pathway with rapid access to a one stop clinic facilitated linkage to care. Many new diagnoses were made in those who would not have otherwise been offered testing and we successfully re-engaged known but disengaged patients. We couldn’t contact half of those diagnosed, particularly those with no fixed abode.
Disclosure of Interest S Douthwaite Conflict with: Gilead sciences, H Evans Conflict with: Gilead sciences, S Balasegaram Conflict with: Gilead sciences, T Wong Conflict with: Gilead sciences, G Nebbia Conflict with: Gilead sciences
- Emergency Department
- hepatitis B
- Hepatitis C
- Linkage to care
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