A Universal Testing Programme for Blood Borne Viruses in an Urban Emergency Department – a call for widespread ED testing in Ireland S O’Connell1, D Lillis2, S O’Dea1, H Tuite4, C Fleming4, H Barry5, L Dalby5, D Shields2, S Norris3, B Crowley5, P Plunkett2, C Bergin1,6

1. Infectious Disease Department, St James’s Hospital, Dublin, Ireland, 2. Emergency Medicine Department, St James’s Hospital, Dublin, Ireland, 3. Hepatology Department, St James’s Hospital, Dublin, Ireland, 4. Infectious Disease Department, University College Hospital Galway, Dublin, Ireland, 5. Microbiology Department, St James’s Hospital, Dublin, Ireland, 6. Department, of Clinical Medicine, Trinity College Dublin, Dublin, Ireland

• A high feasibility and acceptability rate has been achieved at an early point in this study with sustained target uptake rates of higher than 50% achieved.

• The overall prevalence of HIV was 11.9/1000, HBV 4.7/1000 and HCV 54.2/1000• The HIV prevalence found has supported recent data and an unexpectedly high rate of new diagnoses

for HBV and HCV has been found.• High HCV prevalence rates amongst emergency department attendees are noted with a difference in

linkage to care rates in this virus group.• These results suggest a roll out to widespread ED testing in urban areas and general practice is

warranted.• Panel testing may be more effective for this purpose.

• A high feasibility and acceptability rate has been achieved at an early point in this study with sustained target uptake rates of higher than 50% achieved.

• The overall prevalence of HIV was 11.9/1000, HBV 4.7/1000 and HCV 54.2/1000• The HIV prevalence found has supported recent data and an unexpectedly high rate of new diagnoses

for HBV and HCV has been found.• High HCV prevalence rates amongst emergency department attendees are noted with a difference in

linkage to care rates in this virus group.• These results suggest a roll out to widespread ED testing in urban areas and general practice is

warranted.• Panel testing may be more effective for this purpose.

1. Background 2. Methods

4. Conclusion

3. Results

• An opt-out screening program for Blood Borne Viruses (BBV) including HIV antibody, Hepatitis B surface antigen and Hepatitis C antibody was introduced in March 2014 in our Emergency Department.

• All patients undergoing blood sampling in the department as part of routine clinical care were offered serological testing for the above viral panel.

• The primary aim of our study was is to assess feasibility and acceptability of this screening approach. A secondary aim was to describe prevalence rates of both new and known HIV, HBV and HCV infections

• Targets for uptake of BBV panel in those who had bloods drawn were set at 50% for month 1 and 2 and 80% from month 3 onwards.

• Over the first 20 weeks of testing, results of screening 5299 patients were obtained.• A sustained target rate of >50% was obtained after week 3.

1. Number of Diagnoses

• Recent studies show that at least 2 per 1000 people in the greater Dublin area have been diagnosed with HIV infection.

• Prevalence rates for Hepatitis C infection in Ireland have varied in previous studies from 0.5-1.2%.• True Hepatitis B prevalence rate in Ireland is unknown,• Given the recent improvement in treatment options for HIV and Hepatitis C and sustained late

presentation of new HIV diagnoses, Emergency Medicine, Infectious Diseases, Hepatology and Laboratory Medicine collaboratively proposed a universal screening programme for the above 3 infections as a pilot study.

2.Linkage to Care at time of screening

3.Linkage to Care subsequent to diagnosis (New and previously known patients)

6. References

•The majority (79%) of patients with known Hepatitis C are now re-linked to care as a result of the study team intervention. •Those with newly diagnosed Hepatitis C are being actively followed up on an ongoing basis.

1. Tuite H, Horgan M, Mallon P, McConkey S, Mooka B, Mulcahy F, et al. Antiretroviral Treatment and Viral Load Responses in HIV-infected Patients Accessing Specialist Care in Ireland. European conference of Clinical Microbiology and Infectious Diseases; London 2012

2. Thornton L, Murphy N, Jones L, Connell J, Dooley S, Gavin S et al. Determination of the burden of hepatitis C virus infection in Ireland. Epidemiology Infect. 2011 Sep 19:1-83. Health Protection Surveillance Centre, Infectious Disease Notifications in Ireland, 2004-2013

4. Health Protection Surveillance Centre, Ireland known incidence vs EDVS incidence and prevalence

Total New diagnoses Previously known Prevalence rate of new diagnoses (per 1000)

HIV 63 6 57 1.13

HBV 25 12 13 2.25

HCV 287 44 243 8.3

Previously known Linked Defaulted

HIV 57 98.2% (n= 56) 1.8% (n= 1)

HBV 13 92.3% (n= 12) 7.7% (n= 1)

HCV 243 58% (n= 141) 42% (n= 102)

Known New Now linked

HIV 57 6 62 (98.4%)

HBV 13 12 24 (96%)

HCV 243 44 227 (79%)

HPSC3 Incidence EDVS Incidence

HIV 7.5/100,000 111/100,000

HBV 12.6/100,000 230/100,000

HCV 22.6/100,000 810/100,000