Factors Influencing Uptake of Rapid HIV and Hepatitis C Screening Among Drug Misusing Adult Emergency Department Patients: Implications for Future HIV/HCV Screening Interventions

Abstract Background Despite hepatitis C virus (HCV) age cohort and risk factor screening recommendations, many at-risk individuals remain undiagnosed. Current screening practices may not adequately capture those at high risk for infection, especially in regions with increasing injection drug use (IDU). Universal HCV screening in a Tennessee tertiary care emergency department (ED) was introduced to help define regional epidemiology and to improve diagnosis and linkage to care. Methods This screening program was implemented in the Vanderbilt University Medical Center ED. Adult patients who underwent phlebotomy for clinical purposes were offered HCV screening. Samples were initially tested for HCV antibodies; if positive, samples were reflexed for HCV RNA testing. Patients with positive HCV RNA tests (i.e., active HCV infection) were notified, counseled, and offered linkage to care. Results A total of 11,637 screening tests were performed between April 1, 2017 and March 31, 2018, with 1,008 (8.7%) HCV antibody positive and 488 (4.2%) RNA positive. Of note, 81 (0.7%) were HCV antibody positive but RNA testing could not be performed due to insufficient sample volume. Several notable populations had high rates of HCV (Table 1). Importantly, 3.9% of people not born between 1945 and 1965 were HCV RNA positive, and they were the majority (63.5%) of patients with active HCV (Table 2). A minority (31.6%) of those with active HCV had a known history of IDU (Table 2). Conclusion HCV is common among patients presenting for emergency care at a Tennessee tertiary care ED. Universal screening identified many infections that would have been missed using age cohort and risk factors alone. ED HCV screening may be a useful method to augment guideline-based testing and intervene among populations not consistently screened. Disclosures C. A. Chastain, Gilead Sciences, Inc.: Grant Investigator and Research Contractor, Grant recipient and Research support. J. Johnson, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. K. Miller, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. J. H. Han, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. W. H. Self, Gilead Sciences, Inc.: Grant Investigator, Grant recipient.

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308. Slow Adoption of a Nurse-Driven Protocol for Universal Hepatitis C Virus Screening in a Hospital Emergency Department: Lessons Learned

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.381 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S165-S165

Author(s):

Zainab Wasti ◽

Dagan Coppock ◽

Zsofia Szep ◽

Tiffany Scott ◽

Taneesa Franks ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Baby Boomers ◽

Public Health Intervention ◽

Lessons Learned ◽

Seroprevalence Rate ◽

Screening Protocol ◽

Hcv Screening ◽

Hcv Testing

Abstract Background In areas with a high prevalence of hepatitis C virus (HCV) infection, emergency department (ED) visits may provide unique opportunities for screening. The catchment area for Hahnemann University Hospital (HUH) has an HCV seroprevalence rate of >20%. However, limited data exist addressing HCV testing strategies in the ED. This study describes the experience of piloting a nurse-driven HCV screening protocol in an urban hospital ED. Methods A nurse-driven HCV screening protocol was developed and implemented on August 1, 2018. We performed a retrospective analysis of the protocol’s performance from July 1, 2018, through December 31, 2018. Patients who were evaluated in the ED and had blood collected were analyzed. We provided universal HCV screening regardless of age or risk factors. If HCV-positive by antibody screen and viral load confirmation, an attempt was made to link patients to care. Linkage was defined as having received an inpatient evaluation by either infectious diseases or hepatology physician. Results Among 20,705 unique patients seen in the ED, 7841 (38%) had blood work collected. 821 (10.5%) patients had HCV antibody testing. After the implementation of the nurse-driven protocol, the testing rate increased from 68/1340 (5.1%) to 753/6501 (11.6%). 260 Baby Boomers (born between 1945–1965) were screened, of which 60 (23.1%) had positive screens. 561 non-Baby Boomers were screened, of which 30 (5.4%) had positive screens. Barriers of implementing nurse-driven protocol were: (1) multiple steps of the ordering process in the electronic medical record (EMR), (2) the complexity of staff schedules, and (3) staff concerns regarding the disclosure of HCV test results. Among the patients who were diagnosed with chronic HCV, 60 % were linked to care for treatment. Conclusion We piloted a nurse-driven universal HCV testing protocol in the ED of a hospital with high HCV prevalence. Though the screening rate doubled, it was still low. We identified barriers that may be addressed to improve future screening rates. In areas with a high seroprevalence of HCV, universal screening may be an excellent public health intervention to identify asymptomatic HCV-infected patients. Disclosures All authors: No reported disclosures.

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Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2020/5258289 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Kelsey Ragan ◽

Anjali Pandya ◽

Tristan Holotnak ◽

Katrina Koger ◽

Neil Collins ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

High Risk ◽

Drug Use ◽

Hcv Rna ◽

High Risk Patients ◽

Risk Patients ◽

History Of ◽

Hcv Screening

Background. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. Methods. A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. Results. Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9–7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.

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211 Hepatitis C Risk Factors in Emergency Department Patients Participating in a Universal Hepatitis C Screening Program

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2019.08.379 ◽

2019 ◽

Vol 74 (4) ◽

pp. S83

Author(s):

E. Cowan ◽

A. Dinani ◽

J. Zaheer ◽

S. Brandspiegel ◽

E. Eiting ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Hepatitis C ◽

Screening Program ◽

Emergency Department Patients

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Using the electronic medical record to increase testing for HIV and hepatitis C virus in an Appalachian emergency department

BMC Health Services Research ◽

10.1186/s12913-021-06482-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carmen N. Burrell ◽

Melinda J. Sharon ◽

Stephen Davis ◽

Judith Feinberg ◽

Elena M. Wojcik ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Medical Record ◽

Electronic Medical Record ◽

Best Practice ◽

Linkage To Care ◽

Patient Navigators ◽

Hcv Screening ◽

Hcv Testing

Abstract Background The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators. Methods EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%. Conclusion HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.

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High prevalence of hepatitis C (HCV) in the emergency department (ED) of a London hospital: should we be screening for HCV in ED attendees?

Epidemiology and Infection ◽

10.1017/s0950268815000199 ◽

2015 ◽

Vol 143 (13) ◽

pp. 2837-2840 ◽

Cited By ~ 11

Author(s):

C. ORKIN ◽

E. LEACH ◽

S. FLANAGAN ◽

E. WALLIS ◽

M. RUF ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C ◽

Cost Benefit ◽

Hcv Rna ◽

London Hospital ◽

High Prevalence ◽

Cost Benefit Ratio ◽

Hcv Antibody ◽

Hcv Screening ◽

The Cost

SUMMARYAn unlinked anonymous study was conducted to estimate the prevalence of hepatitis C virus (HCV) infection in emergency department (ED) attendees at a London Hospital. Nine hundred and ninety-seven samples collected over a 12-day period were tested for HCV antibody (Ab) and reactive samples were further tested for HCV RNA. The HCV seroprevalence was 2·6% (26/997) with 1·2% (12/997) HCV RNA positive. A peak HCV RNA-positive prevalence of 4·8% (3/63) was found in males aged 35–44 years, this was compared to 0% (0/136) in males aged <35 years (P = 0·0614) and 1·4% (4/278) in males aged ⩾45 years (P = 0·2415). Assuming the cost for HCV Ab is £6 and HCV RNA is £40 per test, screening ED attendees aged 25–54 years would cost £360 per viraemic infection and identify 82% of those who were HCV RNA positive, yielding the most favourable cost/benefit ratio. HCV screening of ED attendees aged 25–54 years in this population could be an effective way of identifying patients and limit onward transmission.

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Hepatitis B and hepatitis C in emergency department patients

Annals of Emergency Medicine ◽

10.1016/s0196-0644(05)81770-6 ◽

1992 ◽

Vol 21 (10) ◽

pp. 1294

Author(s):

Diane Brown

Keyword(s):

Emergency Department ◽

Hepatitis C ◽

Hepatitis B ◽

Emergency Department Patients

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Human immunodeficiency virus, hepatitis B virus and hepatitis C virus seroprevalence in critically ill emergency department patients at a Trauma Care Centre, India

Indian Journal of Medical Microbiology ◽

10.4103/0255-0857.180281 ◽

2016 ◽

Vol 34 (2) ◽

pp. 183-185 ◽

Cited By ~ 2

Author(s):

P Batra ◽

P Mathur ◽

S Bhoi ◽

BT Thanbuana ◽

S Nair ◽

...

Keyword(s):

Emergency Department ◽

Human Immunodeficiency Virus ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Hepatitis B Virus ◽

Virus Hepatitis ◽

Care Centre ◽

B Virus ◽

Immunodeficiency Virus ◽

Emergency Department Patients

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Factors influencing time to computed tomography in emergency department patients with suspected subarachnoid haemorrhage

Emergency Medicine Journal ◽

10.1136/emermed-2016-205785 ◽

2016 ◽

Vol 34 (1) ◽

pp. 20-26 ◽

Cited By ~ 1

Author(s):

Maryam Khan ◽

Marco L A Sivilotti ◽

Michael J Bullard ◽

Marcel Émond ◽

Jane Sutherland ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Subarachnoid Haemorrhage ◽

Factors Influencing ◽

Emergency Department Patients

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LO44: Birth cohort hepatitis C screening in an academic emergency department in Canada: preliminary results

CJEM ◽

10.1017/cem.2020.99 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S23-S23

Author(s):

S. Friedman ◽

C. Capraru ◽

K. Bates ◽

D. Porplycia ◽

T. Mazzulli ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C ◽

Birth Cohort ◽

Screening Program ◽

Hcv Rna ◽

Screening Programs ◽

Hcv Prevalence ◽

Canadian Association ◽

The Us ◽

Hcv Screening

Introduction: Epidemiologic and modeling studies suggest that between 45 and 70% of individuals with chronic hepatitis C virus (HCV) infection in Canada remain undiagnosed. The Canadian Association for the Study of the Liver (CASL) recommends one-time screening of baby boomers (1945-1975). Screening programs in the US have shown a very high prevalence of previously undiagnosed HCV among patients seen in the emergency department (ED). We sought to assess the feasibility of implementing a targeted birth-cohort HCV screening program in a Canadian ED setting. Methods: Patients born from 1945 to 1975 presenting to the ED of a downtown Toronto hospital were offered HCV testing. Patients with life-threatening conditions, unable to provide verbal consent in English or intoxication were excluded. Blood samples were collected by finger prick on Dried Blood Spot (DBS) collection cards and tested for anti-HCV antibody with reflex to HCV RNA. Patients with positive HCV RNA were referred to a liver specialist. Results: During a 27-month period (July 2017 - Sept 2019), 8363 patients in the birth cohort presented to the ED during daytime hours. 80% (6714) met eligibility criteria, and 48.4% (3247) were offered testing. Screening was performed by non-medical staff (mean 8/day, median spots on DBS 4). 345 (10.6%) had been previously tested, and 639 (19.7%) declined. 2136 (65.8%) patients underwent testing: median age 58.4 years (40-82), 1117 male (52.3%). Of these, 45 patients (2.1%; 95% CI 1.5%-2.7%) were anti-HCV positive: 32 (76.2%) were HCV RNA positive, 10 (23.8%) negative and 3 not done due to inadequate DBS sample. 26 patients (81.3%) were linked to care and 3 (9.4%) lost to follow-up. HCV prevalence in the ED was significantly higher than the general Canadian population (2.1% vs 0.7%; p < 0.0001) but much lower than reported rates in American EDs (2.1% vs 10.3%; p < 0.0001). Conclusion: Acceptance of HCV screening in the ED birth cohort was high and easily performed using DBS to ensure the majority of positive samples were tested for HCV RNA. Challenges included implementation that limited number of people tested, and linkage to care for HCV positive patients. HCV prevalence among this ED birth cohort was higher than the general population but lower than seen in the ED in the US. This may in part be due to exclusion of individuals with more severe medical issues, refusal by higher risk subgroups, or population and healthcare system differences between countries.

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