Transcript AASLD poster 2014 - TARA

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
1. Background
2. Methods
• 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.
• 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.
3. Results
• 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
Total
New diagnoses
Previously known
HIV
63
6
57
Prevalence rate of new
diagnoses (per 1000)
1.13
HBV
25
12
13
2.25
HCV
287
44
243
8.3
4. Conclusion
• 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.
2.Linkage to Care at time of screening
HIV
HBV
HCV
Previously known
57
13
243
Linked
98.2% (n= 56)
92.3% (n= 12)
58% (n= 141)
Defaulted
1.8% (n= 1)
7.7% (n= 1)
42% (n= 102)
3.Linkage to Care subsequent to diagnosis (New and previously known patients)
HIV
HBV
HCV
Known
57
13
243
New
6
12
44
Now linked
62 (98.4%)
24 (96%)
227 (79%)
•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.
4. Health Protection Surveillance Centre, Ireland known incidence vs EDVS incidence and prevalence
HIV
HBV
HCV
HPSC3 Incidence
7.5/100,000
12.6/100,000
22.6/100,000
EDVS Incidence
111/100,000
230/100,000
810/100,000
6. References
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 19:1-8
3. Health Protection Surveillance Centre, Infectious Disease Notifications in Ireland, 2004-2013