Introduction A key public health strategy is to increase screening for chronic viral hepatitis. However, rates of testing for Hepatitis B and C in primary care remain low. Given that chronic viral hepatitis may present with an abnormal ALT or hepatic steatosis on imaging, we hypothesised that this population may be a suitable target for increased screening. In 2014, we introduced an integrated pathway for the initial management of suspected non-alcoholic fatty liver disease (NAFLD) in primary care which included hepatitis B and C testing at the point of entry. We examined the impact on screening for viral hepatitis in a catchment population of over 6 00 000.
Method Adults with either a raised ALT or fatty liver on imaging were screened for alcohol misuse and tested for Hepatitis B and C before calculation of a NAFLD Fibrosis Score (NFS). The Virology database APEX, was interrogated for all tests for HBsAg, HBcAb and anti-HCV from primary care between 1 st November 2011 and 31 st October 2016. As a “control” for blood borne virus testing, HIV serology from the same locations and time period were also analysed. Data were scrutinised for number of tests per month pre and post implementation, the number of new diagnoses and the number of those diagnoses attributable to the NAFLD pathway.
Results During the baseline period between November 2011 and April 2014, there were a mean of 173 HBsAg and 139 anti-HCV tests per month from primary care. Following the introduction of the NAFLD pathway, there was a highly significant increase in mean monthly testing to 295 HBsAg and 250 anti-HCV tests per month between May 2014 and October 2016 (p<0.001 for both). Across the same period, HIV testing remained stable with a mean of 68 tests per month prior to and 86 per month following introduction of the pathway (p=0.20, NS). In addition to demonstrating increased testing rates, the algorithm led to new diagnoses of chronic viral hepatitis and we will present further data on the yield of testing for Hepatitis B and C in a community NAFLD population.
Conclusion We demonstrated a significant increase in testing for chronic viral hepatitis in primary care following the implementation of a NAFLD risk assessment pathway. The number of tests per month and number of requests related to NAFLD remained stable for the past 18 months, suggesting the pathway is now integrated into routine primary care practice. The NAFLD pathway represents a potential method to improve detection of chronic Hepatitis B and C infection in the community and we suggest that a similar approach in other CCGs could have additional impact in areas of higher prevalence of hepatitis B and C.
Disclosure of Interest K Bicknell: None Declared, K Fancey: None Declared, K Gamble: None Declared, J Dowman: None Declared, A Fowell: None Declared, R Aspinall Conflict with: AbbVie, Gilead, MSD, Norgine, Falk
- hepatitis B
- hepatitis C
- liver disease
- Primary care
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