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Seroprevalence of HCV, HBV and HIV in two inner-city London emergency departments

  • L. Cieply (a1), R. Simmons (a1) (a2), S. Ijaz (a2) (a3), E. Kara (a1) (a2), A. Rodger (a4) (a5), W. Rosenberg (a2) (a4) (a6), A. McGuinness (a6), J. L. Mbisa (a7), J. Ledesma (a2) (a7), N. Ohemeng-Kumi (a3), S. Dicks (a3), H. Potts (a8), S. Lattimore (a1) (a2) and S. Mandal (a1) (a2)...

Abstract

Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.

Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of black vs. white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95% CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity was more likely among 36–55 year olds vs. ⩾56 years (7.69, 95% CI 2.24–26.41), and less likely among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely to be of black vs. white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: R. Simmons, E-mail: ruth.simmons@phe.gov.uk

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References

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1.Department of Health. Getting ahead of the curve. A strategy for combating infectious diseases (including other aspects of health protection) 2002 [cited 2015 15/12/2015]. Available at http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4060875.pdf.
2.Public Health England. Hepatitis C in the UK: 2018 Report. 2018 [cited 2018 18/12/2018]. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/732469/HCV_IN_THE_UK_2018_UK.pdf.
3.Public Health England. Progress towards ending the HIV epidemic in the United Kingdom: 2018 Report. 2018 [cited 2018 18/12/2018]. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/759408/HIV_annual_report_2018.pdf.
4.Lyons, MS et al. (2005) Health department collaboration with emergency departments as a model for public health programs among at-risk populations. Public Health Reports 120, 259265.
5.Becker, G (2001) Effects of being uninsured on ethnic minorities’ management of chronic illness. The Western Journal of Medicine 175, 1923.
6.Levy, I et al. (2016) Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study. BMJ Open 6, e012721.
7.Ellis, S et al. (2012) HIV diagnoses and missed opportunities. Results of the British HIV Association (BHIVA) National Audit 2010. Clinical Medicine 12, 430434.
8.Wohlgemut, J, Lawes, T and Laing, RB (2012) Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study. BMC Infectious Diseases 12, 72.
9.British HIV Association, British Association for Sexual Health and HIV, British Infection Society (2008) UK National Guidelines for HIV Testing 2008. London: British HIV Association; [13/02/2013]. Available at http://www.bhiva.org/HIVTesting2008.aspx.
10.Baggaley, RF et al. (2017) Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis. Lancet HIV 4, e465e474.
11.National Institute for Health and Care Excellence. HIV testing: encouraging uptake 2017 [cited 2018 18/12/2018]. Available at https://www.nice.org.uk/guidance/qs157/chapter/Quality-statement-1-Hospitals-in-areas-of-high-and-extremely-high-HIV-prevalence.
12.National Institute for Health and Care Excellence. Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection. 2013 [cited 2017 25/07/2017]. Available at https://www.nice.org.uk/guidance/ph43/resources/hepatitis-b-and-c-ways-to-promote-and-offer-testing-draft-guidance2.
13.World Health Organisation. Guidelines on Hepatitis B and C Testing. 2017 [cited 2018 18/12/2018]. Available at http://apps.who.int/iris/bitstream/handle/10665/254621/9789241549981-eng.pdf;jsessionid=F8AADFE840557ECEEA581F7702AE26EA?sequence=1.
14.National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. 2012 [cited 2017 11/08/2017]. Available at https://www.nice.org.uk/guidance/ph43/resources/hepatitis-b-and-c-testing-people-at-risk-of-infection-1996356260293.
15.Evlampidou, I et al. (2016) Low hepatitis B testing among migrants: a cross-sectional study in a UK city. British Journal of General Practice 66, e382e391.
16.Zetola, NM et al. (2008) Prevalence and correlates of unknown HIV infection among patients seeking care in a public hospital emergency department. Public Health Report 123(Suppl. 3), 4150.
17.Glick, NR et al. (2004) HIV testing in a resource-poor urban emergency department. AIDS Eduction and Prevention 16, 126136.
18.Kirsch, TD et al. (1999) Feasibility of an emergency department-based tuberculosis counseling and screening program. Academic Emergency Medicine 6, 224231.
19.Rayment, M et al. (2013) Routine HIV testing in the emergency department: tough lessons in sustainability. HIV Medicine 14(Suppl. 3), 69.
20.Rayment, M et al. (2012) HIV testing in non-traditional settings – the HINTS study: a multi-centre observational study of feasibility and acceptability. PLoS ONE 7, e39530.
21.Hempling, MC, Pakianthan, M and Majewska, W (2011) 011 Pilot project evaluating HIV testing in St George's Emergency Medicine Department. Emergency Medicine Journal 28, A5.
22.Hempling, MC et al. (2016) Routine HIV testing in the emergency department: feasible and acceptable? International Journal of STD & AIDS 27, 12671274.
23.Orkin, C et al. (2016) Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the ‘Going Viral’ campaign. HIV Medicine 17, 222230.
24.Hunter, LDS and Nebbia, G (2016) Detecting hepatitis infection in the emergency department. Emergency Medicine Journal 33, 903904.
25.Public Health England. HCV treatment monitoring report 2018. 2018 [cited 2018 18/12/2018]. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/756748/HCV_treatment_monitoring_report_2018.pdf.
26.Public Health England. Annual Epidemiological Spotlight on HIV in London 2015 data 2017 [cited 2017 21/07/2017]. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/594779/London_HIV_Spotlight_2015_data.pdf.
27.Public Health England. Hepatitis C in London 2015 report 2015 [cited 2017 21/07/2017]. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/478009/Hepatitis_C_in_London_-_2015_report.pdf.
29.Department for Communities and Local Government. English indices of deprivation 2015 2015 [cited 2017 21/07/2017]. Available at https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015.
30.Muller, J et al. (2007) A novel internally controlled real-time reverse transcription-PCR assay for HIV-1 RNA targeting the pol integrase genomic region. Journal of Virological Methods 142, 127135.
31.Garson, JA et al. (2005) Real-time PCR quantitation of hepatitis B virus DNA using automated sample preparation and murine cytomegalovirus internal control. Journal of Virological Methods 126, 207213.
32.Daniel, HD et al. (2008) Quantitation of hepatitis C virus using an in-house real-time reverse transcriptase polymerase chain reaction in plasma samples. Diagnostic Microbiology and Infectious Disease 61, 415420.
33.Cane, P (2011) HIV drug resistance testing. Methods in Molecular Biology 665, 123132.
34.Mellor, J et al. (1995) Investigation of the pattern of hepatitis C virus sequence diversity in different geographical regions: implications for virus classification. The International HCV Collaborative Study Group. Journal of General Virology 76(Pt 10), 24932507.
35.Cunningham, E et al. (2017) Enhanced surveillance of HIV-1 drug resistance in recently infected MSM in the UK. The Journal of Antimicrobial Chemotherapy 72, 227234.
36.Tamura, K et al. (2013) MEGA6: Molecular Evolutionary Genetics Analysis version 6.0. Molecular Biology and Evolution 30, 27252729.
37.Kalaghatgi, P et al. (2016) Geno2pheno[HCV] – a web-based interpretation system to support hepatitis C treatment decisions in the era of direct-acting antiviral agents. PLoS ONE 11, e0155869.
38.Shafer, RW (2006) Rationale and uses of a public HIV drug-resistance database. The Journal of Infectious Diseases 194(Suppl. 1), S51S58.
39.Department for Communities and Local Government. Rough Sleeping Statistics Autumn 2016, England 2017 [cited 2017 21/07/2017]. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/585713/Rough_Sleeping_Autumn_2016_Statistical_Release.pdf.
40.Aldridge, RW et al. (2018) High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population. Thorax 73, 557564.
41.Poulos, R et al. (2007) Risk factors and seroprevalence of markers for hepatitis A, B and C in persons subject to homelessness in inner Sydney. Australian and New Zealand Journal of Public Health 31, 247251.
42.Hughes, A et al. (2013) Meeting complex needs: young people with HIV in London. HIV Medicine 14, 145152.
43.Bonacini, M (2011) Alcohol use among patients with HIV infection. Annals of Hepatology 10, 502507.
44.Zucker, DM, Choi, J and Gallagher, ER (2012) Mobile outreach strategies for screening hepatitis and HIV in high-risk populations. Public Health Nursing 29, 2735.
45.Dowey, KE (1993) Alcohol-related attendances at an accident and emergency department. Ulster Medical Journal 62, 5862.
46.Stevens, TB et al. (2014) Prevalence of nonmedical problems among older adults presenting to the emergency department. Academic Emergency Medicine 21, 651658.
47.Surah, S et al. (2013) Use of the Alcohol Use Disorders Identification Test (AUDIT) to determine the prevalence of alcohol misuse among HIV-infected individuals. International Journal of STD & AIDS 24, 517521.
48.Caley, M et al. (2012) Differences in hepatitis B infection rate between ethnic groups in antenatal women in Birmingham, United Kingdom, May 2004 to December 2008. Euro Surveillance 17(30):pii=20228.
49.Mohajer, MA et al. (2012) Internal medicine and emergency medicine physicians lack accurate knowledge of current CDC HIV testing recommendations and infrequently offer HIV testing. Journal of the Internal Association of Physicians in AIDS Care 11, 101108.
50.Partridge, DG, Collini, P and McKendrick, MW (2009) HIV testing: the boundaries. A survey of HIV testing practices and barriers to more widespread testing in a British teaching hospital. International Journal of STD & AIDS 20, 427428.
51.Pringle, K, Merchant, RC and Clark, MA (2013) Is self-perceived HIV risk congruent with reported HIV risk among traditionally lower HIV risk and prevalence adult emergency department patients? Implications for HIV testing. AIDS Patient Care and STDs 27, 573584.
52.Simmons, R et al. (2017) Establishing the cascade of care for hepatitis C in England-benchmarking to monitor impact of direct acting antivirals. Journal of Viral Hepatitis 25, 482490.
53.Silva, A et al. (2007) Implementing an HIV and sexually transmitted disease screening program in an emergency department. Annals of Emergency Medicine 49, 564572.
54.Mehta, SD et al. (2007) Adult and pediatric emergency department sexually transmitted disease and HIV screening: programmatic overview and outcomes. Academic Emergency Medcine 14, 250258.
55.White, DA et al. (2011) HIV screening in an urban emergency department: comparison of screening using an opt-in versus an opt-out approach. Annals of Emergency Medicine 58(1 Suppl. 1), S89S95.
56.d'Almeida, KW et al. (2012) Modest public health impact of nontargeted human immunodeficiency virus screening in 29 emergency departments. Archives of Internal Medicine 172, 1220.
57.Wheatley, MA et al. (2011) Efficacy of an emergency department-based HIV screening program in the Deep South. Journal of Urban Health: Bulletin of the New York Academy of Medicine 88, 10151019.
58.Casalino, E et al. (2012) Twelve months of routine HIV screening in 6 emergency departments in the Paris area: results from the ANRS URDEP study. PLoS ONE 7, e46437.
59.Centers for Disease C, Prevention (2007) Rapid HIV testing in emergency departments – three U.S. sites, January 2005–March 2006. MMWR Morbidity and Mortality Weekly Report 56, 597601.
60.Becker, ML et al. (2013) Feasibility and success of HIV point-of-care testing in an emergency department in an urban Canadian setting. Canadian Journal of Infectious Diseases and Medical Microbiology 24, 2731.
61.Rothman, RE et al. (2012) Factors associated with no or delayed linkage to care in newly diagnosed human immunodeficiency virus (HIV)-1-infected patients identified by emergency department-based rapid HIV screening programs in two urban EDs. Academic Emergency Medicine 19, 497503.
62.Brown, J et al. (2007) Routine HIV screening in the emergency department using the new US Centers for Disease Control and Prevention Guidelines: results from a high-prevalence area. Journal of Acquired Immune Deficiency Syndromes 46, 395401.
63.O'Connell, S et al. (2016) Opt-out panel testing for HIV, hepatitis B and hepatitis C in an urban emergency department: a pilot study. PLoS ONE 11, e0150546.
64.Flower, B et al. (eds) (2017) VirA&EmiC Project Universal Hepatitis C & B Screening with Integrated Linkage to Care in an Urban London Emergency Department – interim results. AASLA The Liver Meeting; Washington DC.

Keywords

Seroprevalence of HCV, HBV and HIV in two inner-city London emergency departments

  • L. Cieply (a1), R. Simmons (a1) (a2), S. Ijaz (a2) (a3), E. Kara (a1) (a2), A. Rodger (a4) (a5), W. Rosenberg (a2) (a4) (a6), A. McGuinness (a6), J. L. Mbisa (a7), J. Ledesma (a2) (a7), N. Ohemeng-Kumi (a3), S. Dicks (a3), H. Potts (a8), S. Lattimore (a1) (a2) and S. Mandal (a1) (a2)...

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