Opt-out screening for HIV, hepatitis B and hepatitis C: Observational study of screening acceptance, yield and treatment outcomes


Opt-out screening for HIV, hepatitis B and hepatitis C: Observational study of screening acceptance, yield and treatment outcomes


Grant, C.,O'Connell, S.,Lillis, D.,Moriarty, A.,Fitzgerald, I.,Dalby, L.,Bannan, C.,Tuite, H.,Crowley, B.,Plunkett, P.,Kennedy, U.,McMahon, G.,McKiernan, S.,Norris, S.,Hughes, G.,Shields, D.,Bergin, C.

Emergency Medicine Journal.


Prospective cohort
Virus targets
Hepatitis B
Hepatitis C
Other targets
HBV testing and linkage to care
HCV testing and linkage to Care
Linkage to care
Screening and diagnosis
Target populations
General Population
Country of development
Target location
Testing strategy
Laboratory-based antibody test
Laboratory-based PCR/RNA (confirmatory) test
Laboratory-based HCV core antigen (cAg) confirmatory test
Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test
Laboratory-based antibody test,Laboratory-based HCV core antigen (cAg) confirmatory test
Countries of included studies

Health outcomes

Receipt of antibody results,Number new diagnoses,Linkage to care

Testing strategy

Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test,Laboratory-based HCV core antigen (cAg) confirmatory test


Background: We initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care. Method(s): From July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months. Result(s): Over the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care. Conclusion(s): Although high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up. Copyright © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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22 Jan 2021