Dr Sarah O’ConnellProf Suzanne Norris Dept of Hepatology, St James’s Hospital Dr Catherine...
Transcript of Dr Sarah O’ConnellProf Suzanne Norris Dept of Hepatology, St James’s Hospital Dr Catherine...
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
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2002 2007 2012 2014
% o
f n
ew
pre
sen
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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