dr sarah o’connellprof suzanne norris dept of hepatology, st james’s hospital dr catherine...
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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
0
10
20
30
40
50
60
70
2002 2007 2012 2014
% o
f n
ew
pre
sen
ters
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