Seroprevalence and demographic factors associated with hepatitis B, hepatitis C and HIV infection from a hospital emergency department testing programme, London, United Kingdom, 2015 to 2016

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.

Universal testing for hepatitis B and hepatitis C in the Emergency Department: A cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

“…In addition to the studies used in our analysis, evidence around the effectiveness of ED testing has been demonstrated across several studies in the UK, including pilot studies, national 'testing weeks', and long term testing studies [8][9][10][11]. Qualitative analyses in the UK also found ED testing to be acceptable, and a valuable practice for patients and staff [46].…”

“…Those who test positive are then contacted and linked to care if they are not engaged in care already. Testing studies have ranged from pilot studies, performing tests over one week, to longer studies in which testing was performed over 12 months [7][8][9][10][11]. The uptake of testing tended to be lower in studies over a longer duration (approximately 25% uptake amongst those eligible) [9][10][11].…”

Population (Antibody) Testing for COVID-19—Technical Challenges, Application and Relevance, an English Perspective

“…England, primarily through the activities of the Public Health Laboratory Service which following reorganization was incorporated into the Health Protection Agency which subsequently became Public Health England has a tradition of conducting population antibody studies for communicable diseases [ 81 ]. Examples include surveys of diphtheria, tetanus and pertussis [ 82 , 83 ], measles, mumps and rubella [ 84 ], and hepatitis/HIV virus infection prevalence [ 85 , 86 ]. Typically, these sero-surveys were underpinned by the availability of suitable validated reference assays and reference sera, the assays used had high sensitivity and specificity, and the antibodies detected showed long term stability.…”

Differences in risk factors for hepatitis B, hepatitis C, and human immunodeficiency virus infection by ethnicity: A large population-based cohort study in British Columbia, Canada

“…To date, many studies assessing the factors associated with HBV, HCV, or HIV monoinfection/coinfection in developed countries have failed to account for ethnicity or immigration status (Butt et al, 2017;Buxton et al, 2010;Hope et al, 2013;McKee et al, 2018), which is especially important for the development of screening programs, given that many developed countries, including Canada, have a significant proportion of their population originating from regions with high HBV, HCV, and HIV prevalence (Joint United Nations Programme on HIV/ AIDS, 2019;Statistics Canada, 2017b;World Health Organization, 2017) and differing patterns of disease transmission (Degenhardt et al, 2016). Additionally, the utility of many of these studies may be limited because they examined only a subset of the HBV/HCV/HIV infection groups (Edmunds et al, 2019;Gétaz et al, 2018;Hwang et al, 2010;Sanchez et al, 2014;Tohme et al, 2013), bundled infection groups together as 'blood-borne infections' (Bundle et al, 2019), or focused on specific population groups (e.g. incarcerated individuals, emergency department patients, people living with HIV) (Bundle et al, 2019;Doyle et al, 2018;Gétaz et al, 2018;Hope et al, 2013;Ireland et al, 2018;Sanchez et al, 2014).…”

“…Additionally, the utility of many of these studies may be limited because they examined only a subset of the HBV/HCV/HIV infection groups (Edmunds et al, 2019;Gétaz et al, 2018;Hwang et al, 2010;Sanchez et al, 2014;Tohme et al, 2013), bundled infection groups together as 'blood-borne infections' (Bundle et al, 2019), or focused on specific population groups (e.g. incarcerated individuals, emergency department patients, people living with HIV) (Bundle et al, 2019;Doyle et al, 2018;Gétaz et al, 2018;Hope et al, 2013;Ireland et al, 2018;Sanchez et al, 2014). Our study addressed this knowledge gap by assessing the factors associated with HBV and/or HCV and/or HIV infection among people of varying ethnic origins within a large population-based cohort in BC, Canada, with the aim of informing infection-screening initiatives within the province.…”