Point-of-care Hepatitis C virus testing and linkage to treatment in an Australian inner-city emergency department

Hutton, Jennie; Doyle, Joseph S; Zordan, Rachel; Weiland, Tracey J; Cocco, A.; Howell, Jessica; Iser, Sarah; Snell, J.; Fry, Stéphanie; New, Kate; Sloane, Richard; Jarman, Matthew; Phan, Dinh-Van; Tran, Sophie; Pedrana, Alisa; Williams, Briony; Johnson, Jen; Glasgow, Susanne; Thompson, Alexander

doi:10.1016/j.drugpo.2019.06.021

Cited by 24 publications

(27 citation statements)

References 27 publications

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“…Point-of-care testing within ED has been proposed as an alternative but is labour-intensive, expensive, adds time to the ED assessment and is unlikely to be an attractive alternative, despite easier LTC. 18 The prevalence of HCVAb was substantially higher in ATSI patients (24% compared to 3% in OB). Social factors present in some ATSI people may explain this.…”

Section: Discussionmentioning

confidence: 88%

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Prince

Pipicella

Fraser

et al. 2020

Journal of Viral Hepatitis

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The World Health Organization has set ambitious viral hepatitis elimination targets; however, difficulties in identifying and engaging patients remain. The emergency visit is an opportunity for enhanced linkage to care (LTC). We assessed the effectiveness of an automated Emergency Department (ED) screening service in identifying patients with hepatitis C (HCV) and achieving LTC. A retrospective evaluation was undertaken, analysing the first 5000 patients screened through an automatic Australian service termed ‘Screening Emergency Admissions at Risk of Chronic Hepatitis’ (SEARCH). Screening was performed for those recommended in the Australian national testing policy, specifically overseas born (OB) and Aboriginal or Torres Strait Islanders (ATSI). Healthcare worker education, patient information materials and opt‐out informed consent were used to test sera already collected for biochemistry assays. 5000 of 5801 (86.2%) consecutive eligible patients were screened (OB: 4778, ATSI: 222) from 14 093 ED presentations. HCV antibody was positive in 181 patients (3.6%); 51 (1.0%) were HCV RNA positive. Of 51 HCV RNA–positive patients, 12 were new diagnoses, 32 were ‘re‐diagnoses’ (aware but lost to follow‐up [LTFU]), and 7 were previously known but treatment contraindicated. LTC was successful in 38 viraemic patients (7 deceased, 4 LTFU, 1 treatment ineligible and 1 declined). Of RNA‐negative patients, 75 were previously treated and 49 had presumed spontaneous clearance. Opt‐out consent was acceptable to all patients and staff involved. ED screening can lead to additional diagnosing and ‘re‐diagnosing’ of HCV, with high rates of LTC. Opt‐out consent and automation removed major obstacles to testing.

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Section: Discussionmentioning

confidence: 88%

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Prince

Pipicella

Fraser

et al. 2020

Journal of Viral Hepatitis

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“…The extremely high prevalence of HCV infection among PWID and people who were incarcerated suggests that these populations are an essential and critical target for intervention in order to achieve viral elimination, as shown also in the Australian study[ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a study conducted in an ED in Melbourne, Australia was published[ 24 ]. In this study, comers to the ED were screened for risk factors and were offered the OraQuick ® oral HCV antibody test.…”

Section: Introductionmentioning

confidence: 99%

Emergency department targeted screening for hepatitis C does not improve linkage to care

Houri¹,

Horowitz²,

Katchman³

et al. 2020

WJG

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BACKGROUND Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease worldwide. New treatments for HCV revolutionized management and prompted the world health organization to set the goal of viral elimination by 2030. These developments strengthen the need for HCV screening in order to identify asymptomatic carriers prior to development of chronic liver disease and its complications. Different screening strategies have been attempted, most targeting high-risk populations. Previous studies focusing on patients arriving at emergency departments showed a higher prevalence of HCV compared to the general population. AIM To identify previously undiagnosed HCV carriers among high risk emergency room attendees and link them to care for anti-viral treatment. METHODS In this single center prospective study, persons visiting the emergency department in an urban hospital were screened by a risk factor-specific questionnaire. The risk factors screened for were exposure to blood products or organ transplantation before 1992; origins from countries with high prevalence of HCV; intravenous drug use; human immunodeficiency virus carriers; men who have sex with men; those born to HCV-infected mothers; prior prison time; and chronic kidney disease. Those with at least one risk factor were tested for HCV by serum for HCV antibodies, a novel oral test from saliva (OraQuick ® ) or both. RESULTS Five hundred and forty-one participants had at least one risk factor and were tested for HCV. Eighty four percent of all study participants had only one risk factor. Eighty five percent of participants underwent OraQuick ® testing, 34% were tested for serum anti-HCV antibodies, and 25% had both tests. 3.1% of patients (17/541) had a positive result, compared to local population incidence of 1.96%. Of these, 82% were people who inject drugs (current or former), and 64% served time in prison. One patient had a negative HCV-RNA, and two patients died from non-HCV related reasons. On review of past medical records, 12 patients were found to have been previously diagnosed with HCV but were unaware of their carrier state. At 1-year follow-up none of the remaining 14 patients had completed HCV-RNA testing, visited a hepatology clinic or received anti-viral treatment. CONCLUSION Targeted high-risk screening in the emergency department identified undiagnosed and untreated HCV carriers, but did not improve treatment rates. Other strategies need to be developed to improve linkage to care in high risk populations.

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“…Various approaches to ED testing for hepatitis have also been reported in many high income countries across Europe and North America, although many are targeted towards those at risk (drug users, or those in birth cohorts), rather than universal opt-out testing [47][48][49][50][51][52][53][54][55][56]. Most of these studies focused on HCV and HIV testing, with few testing for HBV.…”

Section: Comparisons With Other Researchmentioning

confidence: 99%

Universal testing for hepatitis B and hepatitis C in the Emergency Department: A cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

Williams

Vickerman

Smout³

et al. 2022

Preprint

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Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on two long-term studies of the real-world effectiveness of testing in two large ED’s in the UK. MethodsA Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5%-0.9% and an HCV RNA prevalence of 0.9%-1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED’s. Results HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89% to 94% likely to be cost-effective at the threshold, while HCV testing was 94% to 100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥0.25% HBsAg prevalence, and ≥0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study.Conclusions HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines.

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Point-of-care Hepatitis C virus testing and linkage to treatment in an Australian inner-city emergency department

Cited by 24 publications

References 27 publications

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Emergency department targeted screening for hepatitis C does not improve linkage to care

Universal testing for hepatitis B and hepatitis C in the Emergency Department: A cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

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