Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK
Abstract Innovative testing approaches and care pathways are required to meet HIV, hepatitis B (HBV) and hepatitis C (HCV) elimination goals. Routine testing for blood-borne viruses (BBVs) within emergency departments (EDs) is suggested by the European Centre for Disease Prevention and Control but t...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2022-11-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-23602-1 |
| _version_ | 1811230466330591232 |
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| author | Elizabeth Smout Khine Phyu Gareth J. Hughes Lee Parker Roozbeh Rezai Amy Evans Joscelyne McLaren Stephen Bush Sarah Davey Mark A. Aldersley Murad Ruf Emma E. Page |
| author_facet | Elizabeth Smout Khine Phyu Gareth J. Hughes Lee Parker Roozbeh Rezai Amy Evans Joscelyne McLaren Stephen Bush Sarah Davey Mark A. Aldersley Murad Ruf Emma E. Page |
| author_sort | Elizabeth Smout |
| collection | DOAJ |
| description | Abstract Innovative testing approaches and care pathways are required to meet HIV, hepatitis B (HBV) and hepatitis C (HCV) elimination goals. Routine testing for blood-borne viruses (BBVs) within emergency departments (EDs) is suggested by the European Centre for Disease Prevention and Control but there is a paucity of supporting evidence. We evaluated the introduction of routine BBV testing in EDs at a large teaching hospital in northern England. In October 2018, we modified the electronic laboratory ordering system to reflex opt-out HIV, HBV and HCV testing for all ED attendees aged 16–65 years who had a routine blood test for urea and electrolytes (U&Es). Linkage to care (LTC) was attempted for newly diagnosed patients, those never referred and those who had previously disengaged from care. The project operated for 18 months, here we present evaluation of the initial nine months (2 October 2018–1 July 2019). We analysed testing uptake, BBV seropositivity, LTC and treatment initiation within six months post-diagnosis. Over 9 months, 17,026/28,178 (60.4%) ED attendees who had U&Es performed were tested for ≥ 1 BBV. 299 active BBV infections were identified: 70 HIV Ab/Ag-positive (0.4% seroprevalence), 73 HBsAg-positive (0.4%) and 156 HCV RNA-positive (1.0%). Only 24.3% (17/70) HIV Ab/Ag-positive individuals required LTC, compared to 94.9% (148/156) HCV RNA-positive and 53.4% (39/73) HBsAg-positive individuals. LTC was successful in 94.1% (16/17) HIV Ab/Ag-positive and 69.3% (27/39) HBsAg-positive individuals. However, at 6 months LTC was just 39.2% (58/148) for HCV RNA-positive individuals, with 64% (37/58) of these commencing treatment. Universal opt-out ED BBV testing proved feasible and effective in identifying active BBV infections, especially among marginalised populations with reduced healthcare access. Our integrated approach achieved good LTC rates although further service development is necessary, particularly for HCV RNA-positive people who inject drugs. |
| first_indexed | 2024-04-12T10:29:46Z |
| format | Article |
| id | doaj.art-e04403594d444610a4c3cbf1446b315b |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-12T10:29:46Z |
| publishDate | 2022-11-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-e04403594d444610a4c3cbf1446b315b2022-12-22T03:36:52ZengNature PortfolioScientific Reports2045-23222022-11-011211910.1038/s41598-022-23602-1Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UKElizabeth Smout0Khine Phyu1Gareth J. Hughes2Lee Parker3Roozbeh Rezai4Amy Evans5Joscelyne McLaren6Stephen Bush7Sarah Davey8Mark A. Aldersley9Murad Ruf10Emma E. Page11UK Field Epidemiology Training Programme, UK Health Security AgencyLeeds Teaching Hospitals Trust, Leeds General InfirmaryField Service, UK Health Security AgencyLeeds Teaching Hospitals Trust, Leeds General InfirmaryLeeds Teaching Hospitals Trust, Leeds General InfirmaryLeeds Teaching Hospitals Trust, Leeds General InfirmaryLeeds Teaching Hospitals Trust, Leeds General InfirmaryLeeds Teaching Hospitals Trust, Leeds General InfirmaryLeeds Teaching Hospitals Trust, Leeds General InfirmaryLeeds Teaching Hospitals Trust, Leeds General InfirmaryPublic Health, Medical Affairs, Gilead Sciences LtdLeeds Teaching Hospitals Trust, Leeds General InfirmaryAbstract Innovative testing approaches and care pathways are required to meet HIV, hepatitis B (HBV) and hepatitis C (HCV) elimination goals. Routine testing for blood-borne viruses (BBVs) within emergency departments (EDs) is suggested by the European Centre for Disease Prevention and Control but there is a paucity of supporting evidence. We evaluated the introduction of routine BBV testing in EDs at a large teaching hospital in northern England. In October 2018, we modified the electronic laboratory ordering system to reflex opt-out HIV, HBV and HCV testing for all ED attendees aged 16–65 years who had a routine blood test for urea and electrolytes (U&Es). Linkage to care (LTC) was attempted for newly diagnosed patients, those never referred and those who had previously disengaged from care. The project operated for 18 months, here we present evaluation of the initial nine months (2 October 2018–1 July 2019). We analysed testing uptake, BBV seropositivity, LTC and treatment initiation within six months post-diagnosis. Over 9 months, 17,026/28,178 (60.4%) ED attendees who had U&Es performed were tested for ≥ 1 BBV. 299 active BBV infections were identified: 70 HIV Ab/Ag-positive (0.4% seroprevalence), 73 HBsAg-positive (0.4%) and 156 HCV RNA-positive (1.0%). Only 24.3% (17/70) HIV Ab/Ag-positive individuals required LTC, compared to 94.9% (148/156) HCV RNA-positive and 53.4% (39/73) HBsAg-positive individuals. LTC was successful in 94.1% (16/17) HIV Ab/Ag-positive and 69.3% (27/39) HBsAg-positive individuals. However, at 6 months LTC was just 39.2% (58/148) for HCV RNA-positive individuals, with 64% (37/58) of these commencing treatment. Universal opt-out ED BBV testing proved feasible and effective in identifying active BBV infections, especially among marginalised populations with reduced healthcare access. Our integrated approach achieved good LTC rates although further service development is necessary, particularly for HCV RNA-positive people who inject drugs.https://doi.org/10.1038/s41598-022-23602-1 |
| spellingShingle | Elizabeth Smout Khine Phyu Gareth J. Hughes Lee Parker Roozbeh Rezai Amy Evans Joscelyne McLaren Stephen Bush Sarah Davey Mark A. Aldersley Murad Ruf Emma E. Page Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK Scientific Reports |
| title | Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK |
| title_full | Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK |
| title_fullStr | Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK |
| title_full_unstemmed | Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK |
| title_short | Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK |
| title_sort | real world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the uk |
| url | https://doi.org/10.1038/s41598-022-23602-1 |
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