Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Abstract

The World Health Organization has set ambitious viral hepatitis elimination targets; however, difficulties in identifying and engaging patients remain. The emergency visit is an opportunity for enhanced linkage to care (LTC). We assessed the effectiveness of an automated Emergency Department (ED) screening service in identifying patients with hepatitis C (HCV) and achieving LTC. A retrospective evaluation was undertaken, analysing the first 5000 patients screened through an automatic Australian service termed ‘Screening Emergency Admissions at Risk of Chronic Hepatitis’ (SEARCH). Screening was performed for those recommended in the Australian national testing policy, specifically overseas born (OB) and Aboriginal or Torres Strait Islanders (ATSI). Healthcare worker education, patient information materials and opt‐out informed consent were used to test sera already collected for biochemistry assays. 5000 of 5801 (86.2%) consecutive eligible patients were screened (OB: 4778, ATSI: 222) from 14 093 ED presentations. HCV antibody was positive in 181 patients (3.6%); 51 (1.0%) were HCV RNA positive. Of 51 HCV RNA–positive patients, 12 were new diagnoses, 32 were ‘re‐diagnoses’ (aware but lost to follow‐up [LTFU]), and 7 were previously known but treatment contraindicated. LTC was successful in 38 viraemic patients (7 deceased, 4 LTFU, 1 treatment ineligible and 1 declined). Of RNA‐negative patients, 75 were previously treated and 49 had presumed spontaneous clearance. Opt‐out consent was acceptable to all patients and staff involved. ED screening can lead to additional diagnosing and ‘re‐diagnosing’ of HCV, with high rates of LTC. Opt‐out consent and automation removed major obstacles to testing.

Integrating hepatitis C virus screening of baby boomers at a community hospital emergency department

“…We utilized an opt‐out approach that focused on transparency and upfront informed consent by nurses and patient navigator to discuss the value of screening and maximize awareness/education on the disease process. With this strategy, we achieved a 40% screening rate, which is in line with other opt‐out HCV ED studies in literature of 20%–80% screening rates 16,18,24–26 …”

“…With this strategy, we achieved a 40% screening rate, which is in line with other opt-out HCV ED studies in literature of 20%-80% screening rates. 16,18,[24][25][26] We conjecture that 60% refusal to be screened is multifactorial and could be attributed to discussion/education with the patient prior to testing, the patient population that presents to community hospitals and overall variable screening rates reported in the literature. Overall, we have learned that key success drivers of an HCV screening programme in EDs in community settings are fully integrated workflow with minimal interruptions in the ED workflow, utilization of a patient navigator that leads to increased screening rates, automated processes with the help of EMR algorithm developments and regular reporting and quality initiatives.…”

Opt-out universal HCV and HIV screening in a Canadian emergency room: a cross-sectional study

“…As some patients seen in the ER could not be traced back, the use of point-of-care tests could have been advantageous in order to improve results disclosure 37. ER screening can also be an opportunity to re-link to care patients previously diagnosed 38. Unfortunately, as this was not an aim of our study, we cannot comment on linkage to care of the previously diagnosed patients (76 HIV-infected and 109 HCV-infected patients).…”

Finding Cases of Hepatitis C for Treatment Using Automated Screening in the Emergency Department is Effective, but What Is the Cost?

“…is method could reach OB patients or other difficult-to-access groups. Routine testing in the ED has been demonstrated to be effective in detecting blood borne infections in several countries [19,21,22]. However without a mechanism to ensure that testing is performed in all eligible patients without interfering with ED care or relying on human factors, uptake rates are variable and are as low as 27% in one UK study [21].…”