Incorporating <scp>HIV</scp>/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine <scp>UK</scp> Emergency Departments: the “Going Viral” campaign

Orkin, Chloe; Flanagan, Stuart; Wallis, Emma; Ireland, Georgina; Dhairyawan, Rageshri; Fox, John; Nandwani, Rak; O’Connell, Rebecca; Lascar, Monica; Bulman, J.; Reeves, Iain; Palfreeman, Adrian; Foster, Graham R.; Keshtkar, Ahmad; Anderson, Jane; Tong, C. Y. William; Lattimore, Sam

doi:10.1111/hiv.12364

Cited by 57 publications

(122 citation statements)

References 34 publications

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“…Higher positive rates and lower numbers needed to screen to detect 1 case have been found in birth cohort studies in higher prevalence settings and countries, such as the United States. 15,26,37,42 Detected positive rates were higher in those with a hepatitis exposure risk factor, a finding in line with studies targeting risk factors. 15,26 Using a risk group instead of the birth cohort, however, would have missed 22% to 54% of all positive cases in this study (3 of 7 anti-HCV-positive cases, 2 of 9 HBsAg-positive cases, and 77 of 142 anti-HBc-positive cases).…”

Section: Discussionsupporting

confidence: 82%

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing

et al. 2018

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PURPOSE Both chronic hepatitis C (HCV) and B virus (HBV) infections are generally asymptomatic, and many remain undetected or are diagnosed at a late stage. Studies that evaluate best practice hepatitis testing strategies are needed to better detect this hidden population. METHODSIn this prospective cohort study, we aimed to determine the diagnostic yield (test uptake and rate of positive test results) of a combined public health and primary care birth cohort testing strategy in detecting hidden cases of HCV and HBV infections. We invited all patients aged between 40 and 70 years (n = 6,743) registered with 11 family practices serving 2 higher prevalence areas, or hotspots (ie, estimated HCV prevalence of 1%; national estimated prevalence is 0.1-0.4%), in the south of the Netherlands. RESULTSTest uptake was 50.9% (n = 3,434 patients). No active or chronic HCV infection was detected: 0.00% (95% CI, 0.00%-0.11%). Positive test rates were 0.20% (95% CI, 0.08%-0.42%) for anti-HCV (n = 7), 0.26% (95% CI, 0.12%-0.50%) for hepatitis B surface antigen (n = 9), and 4.14% (95% CI, 3.49%-4.86%) for antihepatitis B core (n = 142).CONCLUSIONS This best practice testing strategy was effective in achieving a high test uptake. It completely failed, however, to detect hidden chronic HCV infections and is not recommended for countries with a low prevalence of the disease.

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Section: Discussionsupporting

confidence: 82%

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing

et al. 2018

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“…National HIV Testing Week increased testing from 4–9% before to 8–28% during the week , and it also resulted in half of those having blood samples collected at a hospital being tested for HIV . During the regional Go Viral campaign, 27% of patients were tested for blood‐borne viruses (BBVs) .…”

Section: Resultsmentioning

confidence: 99%

“…National HIV Testing Week increased testing from 4-9% before to 8-28% during the week [111,124], and it also resulted in half of those having blood samples collected at a hospital being tested for HIV [21]. During the regional Go Viral campaign, 27% of patients were tested for blood-borne viruses (BBVs) [97]. There were two educational interventions targeting patients; one for pregnant women [90], which resulted in an increase in testing coverage (from 87 to 92%) after provision of a patient information leaflet and one for patients admitted to a hospital inpatient unit, where there was a decline in test offer (from 8 to 0%) [95].…”

Section: Other Hiv Testing Strategies Targeted To Patientsmentioning

confidence: 99%

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

et al. 2019

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Objectives Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). Methods Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010–2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014–2017). Two reviewers independently performed study selection, data extraction and critical appraisal. Results One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9–94% in primary care compared to 3.9–66% in emergency departments. HIV test positivity was lower in emergency departments (0–1.3%) and antenatal services (0–0.05%) than in other hospital departments (e.g. inpatients: 0–5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9–72% before to 12–85% after their implementation, with most studies reporting a 10–20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77–93%). Conclusions This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.

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“…An extension of this would be to adopt an opt‐out model, where patients receiving any routine blood test would also be tested for a blood‐borne virus, which removes the requirement for a discussion on risk factors. This has been demonstrated to have a positive impact on HCV testing in hospital settings . A recent study in Ireland on opt‐out testing for all patients having routine blood tests in general practice described low levels of opt‐out (10.5%), but the yield for case finding was low with only two new HCV and hepatitis B diagnoses made among more than 1000 patients over a 6‐month period …”

Section: Discussionmentioning

confidence: 99%

Limited impact of awareness‐raising campaigns on hepatitis C testing practices among general practitioners

McLeod

Cullen

Hutchinson

et al. 2017

Journal of Viral Hepatitis

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The global hepatitis strategy calls for increased effort to diagnose those infected, with a target of 90% diagnosed by 2030. Scotland's Action Plan on Hepatitis C included awareness-raising campaigns, undertaken during 2008-2011, to promote testing by general practitioners. We examined hepatitis C virus (HCV) testing practice among general practitioners before and following these campaigns. Scottish general practitioners were surveyed, using Dillman's method, in 2007 and 2013; response rates were 69% and 60%, respectively. Most respondents offer testing when presented with a risk history (86% in 2007, 88% in 2013) but only one-fifth actively sought out risk factors (19% in 2007, 21% in 2013). Testing was reportedly always/almost always/usually offered to people who inject drugs (84% in 2007, 87% in 2013). Significant improvements in the offer of testing were reported in patients with abnormal LFTs (41% in 2007, 65% in 2013, P<.001) and who had received medical/dental treatment in high prevalence countries (14% in 2007, 24% in 2013, P=.001). In 2013, 25% of respondents had undertaken HCV-related continued professional development. This group was significantly more likely to actively seek out risk factors (P=.009) but only significantly more likely to offer a test to patients who had received medical/dental treatment in high prevalence countries (P=.001). Our findings suggest that government-led awareness raising campaigns have limited impact on general practitioners' testing practices. If the majority of the HCV-infected population are to be diagnosed, practitioner-based or physician-centred interventions should be considered alongside educational initiatives targeted at professionals.

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Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the “Going Viral” campaign

Cited by 57 publications

References 34 publications

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

Limited impact of awareness‐raising campaigns on hepatitis C testing practices among general practitioners

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