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.
|Publication status||Published - 4 Jul 2019|
Bibliographical noteFunding Information:
Many thanks go to the staff and patients of the Royal London Hospital emergency department, whose participation made this programme possible. A number of individuals made valuable contributions to this work: Murad Ruf from Gilead gave advice regarding submission of the grant application, Bhavi Trivedi assisted with data extraction from RLH IT systems and Vince Lawlor supported with patient notification and recall. NB would also like to thank Ioannis Karagiannis from FETP for supervisory support during his fellowship.
Funding: This work was supported by an educational grant via the Gilead UK and Ireland Fellowship Programme. No representatives from Gilead had any involvement in data analysis, interpretation of findings or the preparation of this manuscript. NB’s salary is paid by the UK Field Epidemiology Training Programme (FETP), Public Health England. This paper is in honour of Cheuk YW Tong who sadly passed away before its publication.
© 2019, European Centre for Disease Prevention and Control (ECDC). All rights reserved.