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Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes
  1. Conor Grant1,
  2. Sarah O'Connell1,
  3. Darren Lillis2,
  4. Anne Moriarty1,
  5. Ian Fitzgerald3,
  6. Linda Dalby3,
  7. Ciaran Bannan1,
  8. Helen Tuite1,
  9. Brendan Crowley3,
  10. Patrick Plunkett2,
  11. Una Kennedy2,
  12. Geraldine McMahon2,
  13. Susan McKiernan4,
  14. Suzanne Norris4,
  15. Gerard Hughes5,
  16. Darragh Shields2,
  17. Colm Bergin1
  1. 1 Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
  2. 2 Department of Emergency Medicine, St. James's Hospital, Dublin, Ireland
  3. 3 Department of Clinical Microbiology and Virology, St. James's Hospital, Dublin, Ireland
  4. 4 Department of Hepatology, St. James's Hospital, Dublin, Ireland
  5. 5 Department of Finance, St. James's Hospital, Dublin, Ireland
  1. Correspondence to Dr Conor Grant, Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland; grantcf{at}tcd.ie

Abstract

Background We initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care.

Methods From July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months.

Results Over the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care.

Conclusion Although high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.

  • HIV
  • viral
  • statistics
  • research, clinical
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Footnotes

  • Contributors CB and the Emergency Department Viral Screening working group are responsible the creation of and management of the screening programme that has been standard of care at our hospital since July 2015. CG was responsible for analysing the screening data, collating and analysing the clinical data, and writing the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement statement There was no formal patient and public involvement (PPI) mechanism involved in the design of this screening programme and study. A formal qualitative evaluation of the patient experiences arising from the screening programme is planned.

  • Patient consent for publication Not required.

  • Ethics approval Ethics was approved by the Tallaght University Hospital / St. James's Hospital Joint Research Ethics Committee

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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