Liverpool Hospital, Sydney, NSW, Australia.
The University of New South Wales, Sydney, NSW, Australia.
J Viral Hepat. 2021 Jan;28(1):121-128. doi: 10.1111/jvh.13393. Epub 2020 Sep 21.
The World Health Organization has set ambitious viral hepatitis elimination targets; however, difficulties in identifying and engaging patients remain. The emergency visit is an opportunity for enhanced linkage to care (LTC). We assessed the effectiveness of an automated Emergency Department (ED) screening service in identifying patients with hepatitis C (HCV) and achieving LTC. A retrospective evaluation was undertaken, analysing the first 5000 patients screened through an automatic Australian service termed 'Screening Emergency Admissions at Risk of Chronic Hepatitis' (SEARCH). Screening was performed for those recommended in the Australian national testing policy, specifically overseas born (OB) and Aboriginal or Torres Strait Islanders (ATSI). Healthcare worker education, patient information materials and opt-out informed consent were used to test sera already collected for biochemistry assays. 5000 of 5801 (86.2%) consecutive eligible patients were screened (OB: 4778, ATSI: 222) from 14 093 ED presentations. HCV antibody was positive in 181 patients (3.6%); 51 (1.0%) were HCV RNA positive. Of 51 HCV RNA-positive patients, 12 were new diagnoses, 32 were 're-diagnoses' (aware but lost to follow-up [LTFU]), and 7 were previously known but treatment contraindicated. LTC was successful in 38 viraemic patients (7 deceased, 4 LTFU, 1 treatment ineligible and 1 declined). Of RNA-negative patients, 75 were previously treated and 49 had presumed spontaneous clearance. Opt-out consent was acceptable to all patients and staff involved. ED screening can lead to additional diagnosing and 're-diagnosing' of HCV, with high rates of LTC. Opt-out consent and automation removed major obstacles to testing.
世界卫生组织设定了雄心勃勃的病毒性肝炎消除目标；然而，发现和接触患者仍然存在困难。急诊就诊是加强联系护理（LTC）的机会。我们评估了一种自动急诊（ED）筛查服务在识别丙型肝炎（HCV）患者并实现 LTC 的有效性。进行了回顾性评估，分析了通过自动澳大利亚服务“筛查有慢性肝炎风险的急诊入院”（SEARCH）筛查的前 5000 名患者。根据澳大利亚国家检测政策，对推荐的人群进行筛查，特别是海外出生（OB）和原住民或托雷斯海峡岛民（ATSI）。使用医疗保健工作者教育、患者信息材料和选择退出知情同意来检测已经为生物化学检测收集的血清。从 14093 例 ED 就诊中筛查了 5801 例（86.2%）连续合格患者（OB：4778 例，ATSI：222 例）。HCV 抗体阳性 181 例（3.6%）；51 例（1.0%）HCV RNA 阳性。51 例 HCV RNA 阳性患者中，12 例为新诊断，32 例为“再诊断”（知晓但失访[LTFU]），7 例为先前已知但治疗禁忌。38 例病毒血症患者成功接受了 LTC（7 例死亡，4 例 LTFU，1 例治疗不合格，1 例拒绝）。RNA 阴性患者中，75 例曾接受治疗，49 例被认为自发清除。选择退出同意得到所有参与患者和工作人员的认可。ED 筛查可导致 HCV 的额外诊断和“再诊断”，LTC 率很高。选择退出同意和自动化消除了检测的主要障碍。
