United Kingdom Field Epidemiology Training Programme, Public Health England, United Kingdom.
Field Epidemiology Service, National Infection Service, Public Health England, London, United Kingdom.
PLoS One. 2018 Jul 25;13(7):e0198520. doi: 10.1371/journal.pone.0198520. eCollection 2018.
Therapies that halt progression of chronic hepatitis B virus (HBV) and achieve a cure for chronic hepatitis C virus (HCV) have encouraged development of innovative strategies to diagnose and link patients to care. We describe the prevalence and risk factors for HBV and HCV infections and use of an opt-out hepatitis testing and integrated linkage to care pathway in a London Emergency Department (ED). ED patients aged ≥16 years having routine blood tests from 15 February-28 March 2016 were tested for hepatitis, unless opted out. Hepatitis B surface antigen (HBsAg) and hepatitis C antibody tests (HCV-Ab, including a confirmatory hepatitis C antigen test (HCV-Ag)) were pre-selected on electronic blood test requests. Linkage to care (attending one clinic appointment) was offered to HBsAg and HCV-Ag patients (new or known-disengaged with care diagnoses). Weighted prevalence estimates and risk factors for seropositivity adjusted by demographics and survey weights were calculated using logistic regression. Hepatitis testing uptake was 56% (3,290/5,865). Overall, 26 HBsAg (10 new diagnoses) and 63 HCV-Ab patients were identified of which 32 were HCV-Ag positive (10 new diagnoses). Weighted seroprevalence of HBsAg was 0.50% (95% CI 0.3-0.8%); HCV-Ab 2.0% (95% CI 1.5-2.7%) and HCV-Ag 1.2% (95% CI 0.8-1.7%). Risk factors for infection were being male (HBsAg: aOR 4.1, 95% CI 1.5-11.3), of non-White British ethnicity (HBsAg: aOR>11) or being homeless (HCV-Ag: aOR 18.9, 95% CI 6.9-51.4). We achieved a high linkage to care uptake for HBsAg (93%) and HCV-Ag (78%) among patients who were contacted and required linkage. A pre-selected hepatitis testing ordering system facilitated a high testing uptake. New and disengaged with care diagnoses and a high HCV prevalence were identified demonstrating the potential to identify and link patients to care in this setting. Strategies connecting clinical care with community outreach services are key for improving patient linkage to care.
治疗慢性乙型肝炎病毒 (HBV) 和丙型肝炎病毒 (HCV) 的进展，并为慢性丙型肝炎病毒 (HCV) 的治疗提供治愈方法，这鼓励了创新策略的发展，以诊断和将患者与护理联系起来。我们描述了在伦敦急诊部 (ED) 中乙型肝炎病毒和丙型肝炎病毒感染的流行率和危险因素，以及使用非选择的肝炎检测和综合联系护理途径。2016 年 2 月 15 日至 3 月 28 日期间，年龄≥16 岁的 ED 患者在进行常规血液检查时，除非选择退出，否则将接受乙型肝炎表面抗原 (HBsAg) 和丙型肝炎抗体检测 (HCV-Ab，包括丙型肝炎抗原检测 [HCV-Ag] 的确认)。电子血液检测请求中预先选择了乙型肝炎表面抗原 (HBsAg) 和丙型肝炎抗原 (HCV-Ag) 检测 (新诊断或已知脱离护理诊断)。为 HBsAg 和 HCV-Ag 患者 (新诊断或已知脱离护理诊断) 提供了联系护理 (参加一次诊所预约)。使用逻辑回归计算了经过人口统计学和调查权重调整的血清阳性率的加权患病率估计值和危险因素。肝炎检测的接受率为 56%(3290/5865)。总体而言，发现 26 例 HBsAg(10 例新诊断)和 63 例 HCV-Ab 患者，其中 32 例 HCV-Ag 阳性(10 例新诊断)。HBsAg 的加权血清阳性率为 0.50%(95%CI 0.3-0.8%)；HCV-Ab 为 2.0%(95%CI 1.5-2.7%)，HCV-Ag 为 1.2%(95%CI 0.8-1.7%)。感染的危险因素是男性(HBsAg：优势比 4.1，95%CI 1.5-11.3)、非白种英国人种(HBsAg：优势比>11)或无家可归(HCV-Ag：优势比 18.9，95%CI 6.9-51.4)。我们成功地实现了 HBsAg(93%)和 HCV-Ag(78%)患者的高联系护理接受率，这些患者已联系并需要联系。一个预先选择的肝炎检测订单系统促进了高检测接受率。新诊断和脱离护理诊断以及高 HCV 患病率表明，在这种情况下有可能发现和联系患者接受护理。将临床护理与社区外展服务联系起来的策略是改善患者联系护理的关键。
