Immunisation, Hepatitis and Blood Safety Department,Centre for Infectious Disease Surveillance & Control (CIDSC), National Infection Service, Public Health England,London,UK.
The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London,London,UK.
Epidemiol Infect. 2019 Jan;147:e145. doi: 10.1017/S0950268819000360.
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.
在本文中，我们基于在急诊部（ED）中进行人类免疫缺陷病毒（HIV）检测的可行性研究工作，估计了在伦敦两家内部 ED 就诊的人群中乙型肝炎、丙型肝炎和 HIV 感染的流行率，确定了 ED 中检测呈阳性的相关因素。我们还进行了分子特征分析，以观察这些个体中循环病毒的多样性，以及对治疗和控制有影响的临床显著突变的存在情况。非传统环境中的血液传播病毒（BBV）检测是可行的，急诊部（ED）可能能够有效地接触到弱势群体和服务不足的人群。我们研究了在伦敦的两家内部 ED 内进行 BBV 检测的可行性。2015 年 1 月至 6 月期间，在伦敦皇家自由医院（RFLH）或伦敦大学学院医院（UCLH）急诊部接受生化检查的成年人（≥18 岁）的剩余样本接受了人类免疫缺陷病毒（HIV）Ag/Ab、抗丙型肝炎（HCV）和 HBsAg 检测。对反应性样本进行了 PCR 和序列分析。在分别有 RFLH 和 UCLH 残留样本（分别为 1287 和 1546 人）的人群中，HBsAg 的血清阳性率为 1.1%和 1.0%，抗 HCV 为 1.6%和 2.3%，HCV RNA 为 0.9%和 1.6%，HIV 为 1.3%和 2.2%。对于 RFLH，HBsAg 阳性的可能性在黑人与白人种族（比值比 9.08；95%置信区间 2.72-30）之间更高，而女性抗 HCV 阳性的可能性较低（0.15，95%置信区间 0.04-0.50）。对于 UCLH，HBsAg 阳性的可能性在非白人种族（亚洲为 13.34，95%置信区间 2.20-80.86；黑人 8.03，95%置信区间 1.12-57.61；其他/混合 8.11，95%置信区间 1.13-58.18）中更高。36-55 岁与≥56 岁的人（7.69，95%置信区间 2.24-26.41）相比，抗 HCV 阳性的可能性更高，而女性的可能性更低（0.24，95%置信区间 0.09-0.65）。HIV 标志物阳性的人更有可能是黑人而不是白人种族（4.51，95%置信区间 1.63-12.45），并且更不可能只到过一次 ED（0.39，95%置信区间 0.17-0.88）或为女性（0.12，95%置信区间 0.04-0.42）。这些结果表明，ED 中的 BBV 检测是可行的，为进一步研究探索提供者和患者的可接受性、转介到护理和成本效益提供了基础。
