Seroprevalence of HCV, HBV and HIV in two inner-city London emergency departments

Abstract

Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of blackvs.white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95% CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity was more likely among 36–55 year oldsvs.⩾56 years (7.69, 95% CI 2.24–26.41), and less likely among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely to be of blackvs.white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.

An Economic Evaluation of the Cost-Effectiveness of Opt-Out Hepatitis B and Hepatitis C Testing in an Emergency Department Setting in the United Kingdom

“…A recent study across 4 UK sites reported a pooled prevalence of 1.69% HCV RNA (range: 0.6%-2.9%), and 0.95% HBsAg (range: 0%-2%), 16 whereas other studies in London EDs have reported HCV RNA or antigen prevalence of 0.9% to 1.6% and HBsAg prevalence of 0.8% to 1.1%. 14,15,17 Thus, our study suggests ED testing is likely to be costeffective in most UK settings. Furthermore, since the general population prevalence of HCV and HBV across Europe (1.1% and 0.9%, respectively) is similar to the base-case ED prevalence used in our analysis, ED testing could be cost-effective in other European settings, and also in other high-income countries with a HCV and HBV prevalence similar to or higher than the United Kingdom.…”

“…These were varied in threshold sensitivity analyses to estimate the minimum prevalence thresholds at which the intervention remains costeffective, since BBV prevalence varies geographically (ranging from 0.6%-2.9% for HCV and 0%-2% for HBV across UK studies). [14][15][16][17] We also performed a sensitivity analysis of testing by age group (16-29, 30-49, 50-69, 701) using stratified prevalence estimates. 14,15 Other model parameters were assumed to remain unchanged due to a lack of age-specific data (see Appendix Table 6 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2 020.03.014).…”

“…11 Emerging UK evidence suggests an additional setting for HCV and HBV case-finding is emergency departments (EDs), as the prevalence of viral hepatitis tends to be higher among ED attendees (up to 2.9% HCV RNA, and 2% HBV HBsAg) compared with the general population, as a result of higher attendance rates among marginalized communities. 5,[12][13][14][15][16][17] In 2019, 25.6 million people attended EDs in England, with approximately 40% receiving blood tests as part of their routine care, providing a valuable opportunity for bloodborne virus (BBV) testing. 14,15,18 The National Institute for Health and Care Excellence (NICE) currently recommends HIV testing in EDs for areas with prevalence of $0.2%.…”

The Role of Targeted HIV Screening in the Emergency Department: A Scoping Review

“…London was the first city in the UK to offer non-targeted HIV screening in the ED, given that the overall prevalence of HIV in London is 5.4/1000 (England 1.9/1000) [83]. Reports of these experiences showed that non-targeted testing was feasible and well accepted by staff and patients and did not adversely affect length of ED stay when offered to patients having routine blood tests [84,85,86,87,88,89,90,91,92]. However, nontargeted screening requires many tests and may include patients previously known to have a HIV positive status.…”

COVID‐19 and beyond: Lessons learned from emergency department HIV screening for population‐based screening in healthcare settings

“…As an example, multiple HIV seroprevalence studies among populations seeking healthcare have indicated that HIV prevalence may be higher here than in the general population. 42,43 These estimates have been critical to HIV surveillance and are anticipated to be critical in COVID-19 surveillance and guide clinical and public health testing and linkage strategies.…”