Hepatitis screening in EDs reaches hard-to-engage patients

An opt-out model of screening for viral hepatitis in high-risk populations presenting to the ED is effective and has a high rate of patient satisfaction.

Dr David Prince, a gastroenterology advanced trainee at Liverpool Hospital, told AGW 2019 that 5,000 Indigenous people and people born overseas were screened at the hospital between July 2018 and February 2019.

The group were adults aged 18-80 years and included people from 130 countries.

No additional blood samples were required as testing was performed on blood samples taken for their presenting condition.

Overall 5.7% tested positive for either or both hepatitis B and hepatitis C.

The study found 29.4% of Indigenous patients had hepatitis C and 2.7% had hepatitis B. In the overseas born patients, 70.6% were positive for hepatitis C and 97.3% for hepatitis B.

Of the viraemic patients, about 80% already knew their status and 20% were new diagnoses. However fewer than 30% of patients were receiving optimal care, he said.

“We came up with the concept of re-diagnosis. A lot of people know they have the condition but they’ve either been told in the past they might not be suitable for treatment or they may have other things going on in their life. So it was about flagging it again and relinking them to care to get them treated,” Dr Prince said.

“People are busy. They are putting food on the table, they are looking after their children, all sorts of things and hepatitis might be the last thing on their mind.”

He said being able to tell them that treatment had moved on from say ten years ago – that it was a tablet every day for eight weeks and then they could be cured – was very positive.

Dr Prince said many patients could not identify a known risk factor.

“Many of these people who migrated to Australia later in their life may have acquired it in childhood when they were vaccinated or in hospital for a medical procedure. But the main thing is they weren’t all current or past people who inject drugs.”

He said while a lot of focus has been put on people who inject drugs in inner city populations, that might not apply in outer metropolitan areas, regional areas or remote areas.

“I think the message from this is that people who are Indigenous or people who are from an overseas, high-risk country, that in itself warrants a discussion about testing.”

Dr Prince said feedback from patients had been overwhelmingly positive; that they were very grateful to know their results and if anything, they wondered why it hadn’t been picked up earlier.

Staff however did have a fear of discussing viral hepatitis and surprisingly, many were unaware of new treatments.

“There has been a lot of fear around viral hepatitis which predates from a time when there weren’t good treatments and there was a lot of stigma around the disease which is still present today.”

“It’s a disease like diabetes, dyslipidaemia, hypertension – we do need to normalise it and that’s the only way really to engage difficult to reach communities and get people on treatment and get it eliminated.”

He said they probably wouldn’t do repeat tests on people who had now been screened.

“Based on the American data on universal screening, it is a one-off screening test unless you have risk factors such as ongoing substance use or other high risk factors.”

He said the next roll-out of the program would probably be across multiple centres in the South Western Sydney Local Health District.

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