Blood-borne viruses (BBVs) cause significant morbidity and mortality worldwide. For populations at high risk of BBVs but less inclined to seek out primary care, Emergency departments (EDs) provide an alternative point of contact. To further understand the potential of BBV testing in this scenario for better case discovery and care coordination, we surveyed the existing literature. Researchers looked for studies on BBV testing in EDs published in English by June of this year. The studies examined seroprevalence surveys, testing’s practicability, its potential to improve patient’s access to care, and the factors that either facilitate or impede its widespread adoption. Gray literature searches were additionally conducted. About 19 papers satisfied the criteria for inclusion; they focused on BBV seroprevalence surveys in EDs (14), feasibility and acceptability (54), and linkage to care (36). The majority of research was done in the United States and focused on the Human immunodeficiency virus (HIV). The seroprevalence rates for hepatitis C virus (HCV), hepatitis B virus (HBV), and HIV were all between 1.5% and 17%. Participation in tests varied from 2% in studies with an opt-in design to 98% in studies with an opt-out design and from 16% in research with a non-consenting design to 91%. The results varied widely, from 13-91% of patients being retained in care to 21-91% of patients being linked to care. Linkage to and retention in care were poorer for those diagnosed with hepatitis C than those diagnosed with HIV. Certain patient features were found to be predictors of linkage to care. Optimal implementation of universal opt-out BBV testing in EDs could improve its feasibility and acceptability. There should be additional cost-benefit analyses of hepatitis testing in emergency departments.
Source: onlinelibrary.wiley.com/doi/10.1111/hiv.13328
