Routine bloodborne virus testing integrates feasibly, effectively, sustainably in UK EDs

Routine testing for bloodborne viruses in EDs proved easily integrated and cost-effective in the U.K., according to a presentation at the International Liver Congress.

“As we’re all aware, bloodborne viruses are a major public health threat, with both the World Health Organization and UNAIDS setting global targets against these infections,” Elizabeth Smout, of Public Health England, said in the presentation. “However, in order to meet these targets, innovative approaches are needed, particularly for testing individuals and engaging those who test positive with care. This is especially important given that many of these infections are asymptomatic and therefore individuals may only present at a late stage when they’ve already developed complications of disease.”

Patients aged 16 to 65 years at Leeds Teaching Hospitals NHS Trust who visited the ED between Oct. 2, 2018, and July 1, 2019, underwent a routine blood test for urea and electrolytes; health care practitioners offered additional testing for hepatitis B and C viruses and HIV antibodies, which patients could decline. For newly and previously diagnosed patients, the ED attempted to initiate linkage to care, according to the abstract.

Smout and colleagues evaluated testing uptake, bloodborne virus seropositivity and linkage to care 6 months after diagnosis and cost-effectiveness of hepatitis screening.

Of 28,178 patients tested for urea and electrolytes, 16,053 (57%) accepted testing for at

least two bloodborne viruses and investigators subsequently discovered 299 active infections, including 70 HIV, 73 HBV and 156 HCV-RNA cases.

Seventeen (24.3%) patients with HIV received linkage to care; 16 connected to care. For HBV cases, 39 (53.4%) required linkage to care; 27 (69.3%) linked to care. HCV-RNA required linkage to care in 148 cases (94.9%); 58 (39.2%) successfully achieved linkage to care.

There was no significant difference between the percentage of patients who achieved sustained virologic response or the linkage to care rates between newly diagnosed and previously diagnosed patients, according to the presentation.

ED testing of HBV and HCV was cost-effective, with 16,812 British pounds per quality adjusted life year (QALY) gained with HBV testing and 6,024 British pounds per QALY gained with HCV testing, both of which were lower than the 20,000 British pounds threshold set by the National Institute for Health and Care Excellence.

“The findings of this work do highlight the challenges we face in achieving the hepatitis elimination goals, and we really now need to focus on supporting individuals with LTC and engaging with treatment, which is going to require us to collaborate closely with community services, particularly drug and alcohol treatment services and services for the homeless,” Smout said.