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Abstract

Background

Progress towards HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) elimination requires local prevalence estimates and linkage to care (LTC) of undiagnosed or disengaged cases.

Aim

We aimed to estimate seroprevalence, factors associated with positive blood-borne virus (BBV) serology and numbers needed to screen (NNS) to detect a new BBV diagnosis and achieve full LTC from emergency department (ED) BBV testing.

Methods

During a 9-month programme in an ED in east London, England, testing was offered to adult attendees having a full blood count (FBC). We estimated factors associated with positive BBV serology using logistic regression and NNS as the inverse of seroprevalence. Estimates were weighted to the age, sex and ethnicity of the FBC population.

Results

Of 6,211 FBC patients tested, 217 (3.5%) were positive for at least one BBV. Weighted BBV seroprevalence was 4.2% (95% confidence interval (CI): 3.6–4.9). Adjusted odds ratios (aOR) of positive BBV serology were elevated among patients that were: male (aOR: 2.7; 95% CI: 1.9–3.9), 40–59 years old (aOR: 1.9; 95% CI: 1.4–2.7), of Black British/Black other ethnicity (aOR: 1.8; 95% CI: 1.2–2.8) or had no fixed address (aOR: 2.9; 95% CI: 1.5–5.5). NNS to detect a new BBV diagnosis was 154 (95% CI: 103–233) and 135 (95% CI: 93–200) to achieve LTC.

Conclusions

The low NNS suggests routine BBV screening in EDs may be worthwhile. Those considering similar programmes should use our findings to inform their assessments of anticipated public health benefits.

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/content/10.2807/1560-7917.ES.2019.24.27.1800377
2019-07-04
2024-04-25
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.27.1800377
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References

  1. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2016-2021 strategy: On the fast-track to end AIDS. Geneva: UNAIDS; 2015.Available from: https://www.unaids.org/sites/default/files/media_asset/20151027_UNAIDS_PCB37_15_18_EN_rev1.pdf
  2. World Health Organization (WHO). Combating hepatitis B and C to reach elimination by 2030. Advocacy brief. Geneva: WHO; 2016. Available from: https://www.who.int/hepatitis/publications/hep-elimination-by-2030-brief/en/
  3. National Institute for Health and Clinical Excellence (NICE). Hepatitis B and C testing: people at risk of infection. Public health guideline PH43. Manchester: NICE; 2012. Available from: https://www.nice.org.uk/guidance/ph43/resources/hepatitis-b-and-c-testing-people-at-risk-of-infection-1996356260293
  4. Public Health England (PHE). Hepatitis C in England: 2017 report. London: PHE; 2017. Available from: http://www.hcvaction.org.uk/sites/default/files/resources/hepatitis_c_in_england_2017_report.pdf
  5. Harris M, Ward E, Gore C. Finding the undiagnosed: a qualitative exploration of hepatitis C diagnosis delay in the United Kingdom. J Viral Hepat. 2016;23(6):479-86.  https://doi.org/10.1111/jvh.12513  PMID: 26924296 
  6. Harris RJ, Thomas B, Griffiths J, Costella A, Chapman R, Ramsay M, et al. Increased uptake and new therapies are needed to avert rising hepatitis C-related end stage liver disease in England: modelling the predicted impact of treatment under different scenarios. J Hepatol. 2014;61(3):530-7.  https://doi.org/10.1016/j.jhep.2014.05.008  PMID: 24824282 
  7. World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO; 2015. Available from: http://apps.who.int/medicinedocs/documents/s22247en/s22247en.pdf
  8. Public Health England (PHE). Annual Epidemiological Spotlight on HIV in London. London: PHE; 2017. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/767460/LondonHIVSpotlight2017.pdf
  9. Public Health England (PHE). Hepatitis B epidemiology in London 2012 data. London: PHE; 2012. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/325941/London_hepatitis_B_report_2012_data.pdf
  10. Harris RJ, Ramsay M, Hope VD, Brant L, Hickman M, Foster GR, et al. Hepatitis C prevalence in England remains low and varies by ethnicity: an updated evidence synthesis. Eur J Public Health. 2012;22(2):187-92.  https://doi.org/10.1093/eurpub/ckr083  PMID: 21708792 
  11. Public Health England (PHE). HIV diagnosed prevalence rate / 1,000 aged 15-59. London: PHE; 2018. Available from: http://fingertips.phe.org.uk/profile/sexualhealth/data#page/3/gid/8000035/pat/6/par/E12000007/ati/102/are/E09000002/iid/90790/age/238/sex/4
  12. Hickson F, Melendez-Torres GJ, Reid D, Weatherburn P. HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities. Sex Transm Infect. 2017;93(7):508-13.  https://doi.org/10.1136/sextrans-2016-052800  PMID: 28348021 
  13. Public Health England (PHE). HIV in the UK 2016 report. London: PHE; 2016. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/602942/HIV_in_the_UK_report.pdf
  14. British HIV Association (BHIVA). UK National Guidelines for HIV Testing 2008. BHIVA; 2008. Available from: https://www.bhiva.org/HIV-testing-guidelines
  15. National Institute for Health and Care Excellence (NICE). HIV testing: increasing uptake among people who may have undiagnosed HIV. NICE; 2016. Available from: https://www.nice.org.uk/guidance/NG60
  16. Orkin C, Flanagan S, Wallis E, Ireland G, Dhairyawan R, Fox J, et al. Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign. HIV Med. 2016;17(3):222-30.  https://doi.org/10.1111/hiv.12364  PMID: 26919291 
  17. Orkin C, Leach E, Flanagan S, Wallis E, Ruf M, Foster GR, et al. High prevalence of hepatitis C (HCV) in the emergency department (ED) of a London hospital: should we be screening for HCV in ED attendees? Epidemiol Infect. 2015;143(13):2837-40.  https://doi.org/10.1017/S0950268815000199  PMID: 25672420 
  18. Rayment M, Thornton A, Mandalia S, Elam G, Atkins M, Jones R, et al. HINTS Study Group. HIV testing in non-traditional settings--the HINTS study: a multi-centre observational study of feasibility and acceptability. PLoS One. 2012;7(6):e39530.  https://doi.org/10.1371/journal.pone.0039530  PMID: 22745777 
  19. White DAE, Anderson ES, Pfeil SK, Deering LJ, Todorovic T, Trivedi TK. Hepatitis C Virus Screening and Emergency Department Length of Stay. PLoS One. 2016;11(10):e0164831.  https://doi.org/10.1371/journal.pone.0164831  PMID: 27760176 
  20. Smith BD, Morgan RL, Becket GA, Falck-Ytter Y, Holtzman D, Teo CG, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep. 2012;61(Rr-4):1-32.
  21. Hsieh YH, Rothman RE, Laeyendecker OB, Kelen GD, Avornu A, Patel EU, et al. Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department. Clin Infect Dis. 2016;62(9):1059-65.  https://doi.org/10.1093/cid/ciw074  PMID: 26908800 
  22. O’Connell S, Lillis D, Cotter A, O’Dea S, Tuite H, Fleming C, et al. Opt-Out Panel Testing for HIV, Hepatitis B and Hepatitis C in an Urban Emergency Department: A Pilot Study. PLoS One. 2016;11(3):e0150546.  https://doi.org/10.1371/journal.pone.0150546  PMID: 26967517 
  23. Russmann S, Dowlatshahi EA, Printzen G, Habicht S, Reichen J, Zimmermann H. Prevalence and associated factors of viral hepatitis and transferrin elevations in 5036 patients admitted to the emergency room of a Swiss university hospital: cross-sectional study. BMC Gastroenterol. 2007;7(1):5.  https://doi.org/10.1186/1471-230X-7-5  PMID: 17280611 
  24. Vermehren J, Schlosser B, Domke D, Elanjimattom S, Müller C, Hintereder G, et al. High prevalence of anti-HCV antibodies in two metropolitan emergency departments in Germany: a prospective screening analysis of 28,809 patients. PLoS One. 2012;7(7):e41206.  https://doi.org/10.1371/journal.pone.0041206  PMID: 22848445 
  25. Parry S, Bundle N, Ullah S, Foster GR, Ahmad K, Tong CYW, et al. Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department - uncovering the iceberg? Epidemiol Infect. 2018;146(8):1026-35.  https://doi.org/10.1017/S0950268818000870  PMID: 29661260 
  26. Greenland S, Pearce N. Statistical foundations for model-based adjustments. Annu Rev Public Health. 2015;36(1):89-108.  https://doi.org/10.1146/annurev-publhealth-031914-122559  PMID: 25785886 
  27. Creswell J, Khowaja S, Codlin A, Hashmi R, Rasheed E, Khan M, et al. An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan. PLoS One. 2014;9(4):e93858.  https://doi.org/10.1371/journal.pone.0093858  PMID: 24705600 
  28. Cornberg M, Razavi HA, Alberti A, Bernasconi E, Buti M, Cooper C, et al. A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel. Liver Int. 2011;31(Suppl 2):30-60.  https://doi.org/10.1111/j.1478-3231.2011.02539.x  PMID: 21651702 
  29. Fettig J, Swaminathan M, Murrill CS, Kaplan JE. Global epidemiology of HIV. Infect Dis Clin North Am. 2014;28(3):323-37.  https://doi.org/10.1016/j.idc.2014.05.001  PMID: 25151559 
  30. Franco E, Bagnato B, Marino MG, Meleleo C, Serino L, Zaratti L. Hepatitis B: Epidemiology and prevention in developing countries. World J Hepatol. 2012;4(3):74-80.  https://doi.org/10.4254/wjh.v4.i3.74  PMID: 22489259 
  31. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57(4):1333-42.  https://doi.org/10.1002/hep.26141  PMID: 23172780 
  32. Gay NJ, Hesketh LM, Osborne KP, Farrington CP, Morgan-Capner P, Miller E. The prevalence of hepatitis B infection in adults in England and Wales. Epidemiol Infect. 1999;122(1):133-8.  https://doi.org/10.1017/S0950268898001745  PMID: 10098796 
  33. Uddin G, Shoeb D, Solaiman S, Marley R, Gore C, Ramsay M, et al. Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin. J Viral Hepat. 2010;17(5):327-35.  https://doi.org/10.1111/j.1365-2893.2009.01240.x  PMID: 20002307 
  34. Evans H, Balasegaram S, Douthwaite S, Hunter L, Kulasegaram R, Wong T, et al. An innovative approach to increase viral hepatitis diagnoses and linkage to care using opt-out testing and an integrated care pathway in a London Emergency Department. PLoS One. 2018;13(7):e0198520.  https://doi.org/10.1371/journal.pone.0198520  PMID: 30044779 
  35. Luiken GPM, Joore IK, Taselaar A, Schuit SCE, Geerlings SE, Govers A, et al. Non-targeted HIV screening in emergency departments in the Netherlands. Neth J Med. 2017;75(9):386-93. PMID: 29219811 
  36. Galbraith JW, Franco RA, Donnelly JP, Rodgers JB, Morgan JM, Viles AF, et al. Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology. 2015;61(3):776-82.  https://doi.org/10.1002/hep.27410  PMID: 25179527 
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