@article{fddf9f8731334667bcbe346b0ad224d4,
title = "VirA+EmiC project: Evaluating real-world effectiveness and sustainability of integrated routine opportunistic hepatitis B and C testing in a large urban emergency department",
abstract = "Innovative testing approaches and care pathways are required to meet global hepatitis B virus (HBV) and hepatitis C virus (HCV) elimination goals. Routine blood-borne virus (BBV) testing in emergency departments (EDs) in high-prevalence areas is suggested by the European Centre for Disease Prevention and Control (ECDC) but there is limited evidence for this. Universal HIV testing in our ED according to UK guidance has been operational since 2015. We conducted a real-world service evaluation of a modified electronic patient record (EPR) system to include opportunistic opt-out HBV/reflex-HCV tests for any routine blood test orders for ED attendees aged ≥16 years. Reactive laboratory results were communicated directly to specialist clinical teams. Our model for contacting patients requiring linkage to care (new diagnoses/known but disengaged) evolved from initially primarily hospital-led to collaborating with regional health and community service networks. Over 11 months, 81,088 patients attended the ED; 36,865 (45.5%) had a blood test. Overall uptake for both HBV and HCV testing was 75%. Seroprevalence was 0.9% for hepatitis B surface antigen (HBsAg) and 0.9% for HCV antigen (HCV-Ag). 79% of 140 successfully contacted HBsAg+patients required linkage to care, of which 87% engaged. 76% of 130 contactable HCV-Ag+patients required linkage, 52% engaged. Our results demonstrate effectiveness and sustainability of universal ED EPR opt-out HBV/HCV testing combined with comprehensive linkage to care pathways, allowing care provision particularly for marginalized at-risk groups with limited healthcare access. The findings support the ECDC BBV testing guidance and may inform future UK hepatitis testing guidance.",
author = "Gaia Nebbia and Murad Ruf and Laura Hunter and Sooria Balasegaram and Terry Wong and Ranjababu Kulasegaram and Julian Surey and Zana Khan and Jack Williams and Basel Karo and Snell, {Luke Blagdon} and Barnaby Flowers and Hannah Evans and Sam Douthwaite",
note = "Funding Information: Gaia Nebbia has no conflict to declare. Murad Ruf is an employee of Gilead Sciences Ltd. Laura Hunter has have received travel grants and research grants from Gilead Sooria Balasegaram has no conflicts to declare. Terry Wong has served on advisory board meetings and as a paid speaker for Gilead, MSD, BMS and Norvartis. Ranjababu Kulasegaram has served as a speaker, consultant and advisory board member for ViiV Healthcare, Gilead Sciences and Merck Sharp & Dohme. Julian Surey has no conflicts to declare. Zana Khan has no conflicts to declare. Jack Williams has received a research grant funded by Gilead. Basel Karo has no conflicts to declare. Luke Snell has no conflicts to declare. Barnaby Flower received a travel grant from Gilead Sciences to attend a conference in 2017. Hannah Evans has no conflicts to declare. Sam Douthwaite has received travel grants from Gilead Sciences. Funding Information: This project was supported through an Association of the British Pharmaceutical Industry (APBI) joint working initiative with Gilead Sciences Ltd. National Health Service (NHS) and Health Security Agency (HSA) partners contributed independent expertise and skills in their own professional capacity without additional financial support. Gilead provided technical expertise, project management and funding for hepatitis B virus and hepatitis C virus testing during the evaluation period, and support for care coordinator. Clinical service delivery, data generation and analysis were done independently by NHS and HSA partners. Content, conclusions and recommendations were agreed by consensus by all authors. Initial data analyses were undertaken by BS (Basel Karo) and SB (Sooria Balasegaram) who are employees of HSA and received funding from Gilead Sciences Ltd. Writing support was provided by Arthur Smyth-Medina (NexGen Healthcare Communications, UK) and funded by Gilead Sciences Ltd Funding Information: This project was supported through an Association of the British Pharmaceutical Industry (APBI) joint working initiative with Gilead Sciences Ltd. National Health Service (NHS) and Health Security Agency (HSA) partners contributed independent expertise and skills in their own professional capacity without additional financial support. Gilead provided technical expertise, project management and funding for hepatitis B virus and hepatitis C virus testing during the evaluation period, and support for care coordinator. Clinical service delivery, data generation and analysis were done independently by NHS and HSA partners. Content, conclusions and recommendations were agreed by consensus by all authors. Initial data analyses were undertaken by BS (Basel Karo) and SB (Sooria Balasegaram) who are employees of HSA and received funding from Gilead Sciences Ltd. Writing support was provided by Arthur Smyth‐Medina (NexGen Healthcare Communications, UK) and funded by Gilead Sciences Ltd Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.",
year = "2022",
month = jul,
doi = "10.1111/jvh.13676",
language = "English",
volume = "29",
pages = "559--568",
journal = "Journal of Viral Hepatitis",
issn = "1352-0504",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "7",
}
