Dr Sarah O’ConnellSt James’s Hospital, Dublin, Ireland

Speaker Name Statement

Dr Sarah O’Connell Dr O’Connell has received a personal grant for research from Gilead Sciences

Date : 30 August 2016

BBV screening in the emergency department: From study to

implementationPrincipal Investigators:

Prof Colm Bergin, GUIDE, St James’s Hospital Prof Suzanne Norris Dept of Hepatology, St James’s Hospital

Dr Catherine Fleming, Dr Helen Tuite, Dept of Infectious Diseases, UCHG

Co-Investigators:GUIDE: Dr Sarah O’Connell, Dr Aoife Cotter

Emergency Medicine: Prof Patrick Plunkett, Dr Una Geary, Dr Darragh Shields, Dr Geraldine McMahon, Dr Darren Lillis

Microbiology: Dr Brendan Crowley, Ms Helen Barry, Ms Linda Dalby, Ian Fitzgerald

Disclosures: This project has been supported with an educational grant via the Gilead UK and Ireland Fellowship Programme.

BBV Epidemiology - Ireland

0

10

20

30

40

50

60

70

2002 2007 2012 2014

% o

f n

ew

pre

sen

ters

HS

MSM

IVDU

Number of notifications of hepatitis B, 1997-2015

Number of notifications of hepatitis C 2004-2015, by

sex and mean age

Why screen?

HIV diagnosed prevalence Ireland* HCV in Ireland pre-DAA era

2.25 per 10000.72 per 1000

1.09 per 1000

*H Tuite, M Horgan, PWG Mallon et al.Patients Accessing Ambulatory Care for HIV-Infection: Epidemiology and Prevalence Assessment. Irish Medical Journal July/August 2015 Volume 108 Number 7 p199-201.

Data from Professor Norris, sourced from HPSC 2013, ICORN 2014, PCRS 2013.

Patient Testing and Follow-Up

Patient registration. Patient information leaflet given to patient.

Patient assessed by triage nurse. Testing procedure explained.

Phlebotomy taken unless patient opts-out/patient excluded

Panel test ordered on Electronic Patient Record (1 click order)

All Results sent to study team who endorse all results

Patients with positive/borderline/not processed test recalled

Follow up arranged where necessary

O’Connell et al, PLOS One 2016

Total ED Bloods19980

Total EDVS10,00050.1%

HIV n=9790 known

99% linked to care

7 new0.8/1000

HBV n=4423 known

87.5% linked to care

20 new2.26/1000

HCV n=447373 known

59% linked to care*

58 new6.5/1000

Pilot Study Results50.4% Male

45 (32,66) years1079 >1 sample taken82 excluded patients

8,839 samples available for analysis

O’Connell et al, PLOS One 2016*Linkage to care rates post-testing: 75%

Challenges Faced• Obtaining ethical approval

• Patient follow-up– Patient/social/disease

characteristics

• Data capture– Demographics – Retrospective chart review

• Chart vs electronic records

• Duplicates– 6 monthly rule

• Uptake rates– Transition from selecting

order to including in care set

• Lack of financial resources

O’Connell et al, PLOS One 2016

Reasons for Success• High levels of communication

• Collaborative team approach

• Enthusiastic ED and laboratory staff

• Ongoing updates – presentations, weekly meetings

• Viral Liaison Nursing role during routine testing programme

O’Connell et al, PLOS One 2016

Routine testing: July 2015-2016Total EDVS

16,256

HIV n=204

186 known

99% linked to care

18 new

1.1/1000

HBV n=78

49 known

96% linked to care

25 new

1.5/1000

HCV n=851

753 known

53% linked to care*

61 new

3.75/1000

*Linkage to care rates post-testing: 86%

Conclusions• High rates of HIV, HBV and HCV found during both screening programmes

• High staff resource needed

• Often patients would not have been tested in another setting– Not perceived to be at risk– Higher proportion of those with no risk identifiable than in national reported data

• Lack of ability to offer DAAs for everyone– Purpose of screening cannot be fulfilled

• Ongoing work required– Linkage to care– QI programme to improve retention in care rates

• Role for molecular POC testing in the ED