Objectives & BackgroundThe National Institute of Clinical Excellence (NICE) and the Royal College of Emergency Medicine recommend that adults should be tested for HIV in endemic areas with a prevalence >0.2%. It is estimated that approximately 25% of those living with HIV are unaware of their diagnosis. Late diagnosis is associated with a ten-fold increased risk of death in the following year,1 and increased risk of onwards HIV transmission. In July 2015 our Emergency Department commenced a pilot project to assess the feasibility of routine HIV testing within a busy inner city ED.MethodsPatients over the age of 16 had an HIV test performed if they required venepuncture during their emergency department attendance. Tests were ordered using a pre-configured blood order set including a pre-selected HIV test. Patients were informed of the intention to test all attendances and were able to opt out if desired. Positive or equivocal results were followed up by our HIV team.ResultsOver 36 weeks, 64% of ED attendances (19,569/30,461) were tested for HIV. Our prevalence was 0.9% (n=172) and of those 0.3% were not aware of their positive HIV status (n=68). Thirteen patients were not currently engaged in services, although aware of their diagnosis. Median age was 36(18–61). Patients who tested positive were predominantly male (84%) and Caucasian (59%) (37% BME, 4% Asian).50% of patients who tested positive self- identified as heterosexual, and 50% as MSM(men who have sex with men). A significant number (54%) of newly diagnosed patients had previously attended our emergency department prior to routine HIV testing. 23% of new diagnoses required an acute admission.ConclusionThe Emergency Department provides a suitable environment for opportunistic HIV testing in areas of high prevalence. We have maintained testing rates of >65% of our ED attendances, achieved early diagnosis and treatment engagement in patients who were unaware of their HIV status. In addition, we have identified a number of patients who had been lost to follow-up and have now re-engaged in care. Use of pre-configured blood order sets, regular staff education and feedback on results improves testing rates.
Objectives & BackgroundHepatitis (HBV&HCV) testing in the UK is currently targeted at groups perceived to be at high risk. Late diagnosis is common. Initial infection may only be accompanied by a mild illness or be completely asymptomatic. Chronic infection can occur and may progress to liver fibrosis, cirrhosis, decompensated liver disease or hepatocellular carcinoma if untreated.1Early diagnosis and treatment are effective in reducing disease progression (HBV) or elimination of the virus (HCV).Our aim was to determine the potential for blood borne virus testing within the ED and to evaluate the burden of HBV/HCV in our local population.MethodsPatients over the age of 16 were offered Hepatitis B (Surface antigen) and Hepatitis C (IgG antibodies) testing, if they required venepuncture during their ED attendance, in a 6 week period from 15th February 2016–27th March 2016. Tests were ordered using a pre-configured order-set including a pre-selected Hep BsAg and HepC IgGAbs. Patients were informed of the intention to test all attendances and were able to opt out if desired. Positive test results were followed up at a rapid access one-stop clinic.ResultsOver a 6 week period, 3073 (49%) and 2982 (47%) accepted testing for Hepatitis B and Hepatitis C respectively. 1.1% (n=35) tested positive for Hepatitis B surface antigen, indicating acute or chronic infection. 2.2% (n=66) tested positive for Hepatitis C antibodies, indicating current or previous HCV infection. Hepatitis C antigen testing was positive in 1.2% (n=35) indicating current HCV infection.The median age of all patients tested was 45 years (16–100 years) female 51%.HBVantibody positive: median age 42 years (24–82 years), Gender: Male 70% Ethnicity: 40% Black or Black British.HCVantigen positive: Median age 41 years (22–77 years) Gender: Male 72%, 40% White British. Two newly diagnosed patients were eligible to be commenced on direct acting anti-virals. One patient had evidence of cirrhosis on initial fibroscan.ConclusionConsider the ED for opportunistic blood borne virus testing in areas of high prevalence. We achieved testing rates of approximately 50% by use of a pre-configured blood order set and an opt-out policy, resulting in identification of new diagnoses and lost to follow-up patients. Use of a one-stop clinic provides rapid entry to care for positive patients and reduces burden of follow-up for the ED.
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