HCVTesting trends

• General remarks on HCV testing

• Trends in HCV testing in NI– An 11 year dataset

• RAGS- blood lab initiative- 2011-2012

HCV infections

80% develop chronic infection

20% clear infection`

`

Antibody positivePCR positive

Antibody positive high levelPCR negative

` Antibody positive low levelPCR negative

Current infection

Past infection

Past infection ORSpurious antibody?

HCV Antibody tests are less perfect than HIV tests

• Low antibody positive PCR negative

• ?past infection• Or• ?Spurious

• E.g fertility occ health etc

Screening EIA (Abbott Architect)

Negative Reactive <3 Reactive >3

Report: Negative

Monolisa Ag/Ab

Negative Positive

HCV Antigen

Report: Negative

Report: No current infection. Either past infection or false positive antibody.

Monolisa Ag/Ab

Negative Positive

Report: Current infection. Ask for second specimen for PCR & genotype. Suggest referral.

See nextslide

Screening EIA (Abbott Architect)

Reactive >3

Monolisa Ag/Ab

Positive

PCR

Negative Positive

Negative

Report: Negative

Report: Current infection.

Ask for second specimen for PCR & genotype.

Suggest referral.

Report: No current infection.

Indicates past infection.

Ask for second specimen

An estimated five out of every six UK people with chronic HCV are unaware of their infection. (2004)

Diagnosed

Undiagnosed

9.6% of HCV tests

15.4% Of HCV tests

5.2% of HCV tests

25.6 % of HCV tests

0.49 % of HCV tests

0.39 % of HCV tests

Source tested Positive % positive

Belfast 10503 19 0.18

Northern 2324 6 0.26

Southern 1982 9 0.45

South Eastern 1477 5 0.34

Western 4102 4 0.1

GP 4282 33 0.77

Other 1281 3 0.23

TOTAL 25951 79 0.3

2010 Positive results Trust/GP

Source tested Positive % positive

OCCUPATIONAL HEALTH 2103 3 0.14

Fertility 1344 0 0

GUM 6632 14 0.21

ADDICTION 127 3 2.4

RENAL 3987 0 0

Prison 101 2 2

2010 Positive results -Specialty

• Trust positivity rate– 0.21%

• GP positivity rate– 0.77%

• Addiction positivity rate– 2.4%

• Prison positivity rate– 2.0%

Virology testing in NI

• Blood lab initiative (2011 2012)

BiochemistryHaematologyImmunology

Microbiology serology (including Virology)

Molecular

The blood lab:RAGS

• Short term– Uncertainty– Diffs

• Longer term– Sustains virology molecular– Better TAT– Scaleable