Outcomes 10 Years After Implementing an Emergency Department Opt-out Bloodborne Virus Screening Program

Abstract

Background. Bloodborne viruses (BBV) such as hepatitis B (HBV), hepatitis C (HCV), and HIV pose significant personal and public health risks. Screening and linkage to treating services are important tools in treatment and preventing onward transmission. This study reports outcomes of 10 years of an opt-out BBV screening program in a large urban emergency department (ED). Methods. Starting in July 2015, ED patients undergoing phlebotomy were offered routine BBV screening. We examine acceptance of screening, characteristics of new diagnoses, and onward linkage to care 10 years after program implementation. We also investigate factors associated with new viremic HCV diagnoses within this cohort to inform future service development. Results. Over the 10-year period, acceptance of BBV screening among phlebotomized patients was high (81%). There was no significant change in rates of new diagnoses of HIV, HBV, or HCV, but there was a significant reduction in polymerase chain reaction–positive HCV diagnoses. Linkage to care was high (96% HIV, 89% HBV, 95% HCV). Polymerase chain reaction–positive HCV was associated with people who inject drugs and being discharged directly from the ED. Conclusions. BBV screening in the ED demonstrates sustained acceptability, with a steady rate of new diagnoses detected. It provides high levels of linkage to care. It also identifies active HCV within a population of people who inject drugs attending the ED who are discharged directly without needing admission.