New data presented today at the British Association for the Study of the Liver Annual Meeting in Harrogate has added weight to calls from the British Liver Trust for opt out blood testing to be made routinely available in all emergency departments across the UK. The research also highlights the urgent need for improvements to ensure adequate follow up and monitoring of patients who have been diagnosed with hepatitis B (HBV).
The British Liver Trust has been calling for the roll out of opt-out testing across all emergency Departments in the UK since testing for HIV, hepatitis B and hepatitis C launched in April 2022 in Emergency Departments in areas of very high HIV diagnosed prevalence. All Emergency Department attendees over 18 years of age who were having blood tests done for any reason, were tested for HIV, hepatitis B and hepatitis C, unless they opted out. The initiative has unearthed a lot more cases of undetected hepatitis B than expected, resulting in a 30% increase in estimated prevalence and surge in demand for HBV services.
Opt-out blood borne virus testing in Emergency departments was rolled out in areas of extremely high HIV prevalence in April 2022. This research described the cases identified through testing at two Emergency Departments in King’s College Hospital NHS Foundation Trust. In the first 18 months, out of the 837 patients who tested positive for viral hepatitis (hepatitis B or C), the majority, 715 (85%) tested positive for hepatitis B. Although 351 (42%) were already in care, almost a quarter (24%) were new diagnoses of hepatitis B, which can cause liver fibrosis, cirrhosis and liver cancer and other serious health complications if left untreated.
56 patients (8%) had previously been diagnosed but were not receiving care or treatment, and a further 40 patients (6%) could not be contacted after the positive test to check that they were aware of their diagnoses. This highlights the need for strategies to ensure that patients with hepatitis B are followed up adequately, which requires information, education and patient involvement. It also identifies the need for research into barriers to accessing care which may include stigma, discrimination and language barriers.
Pamela Healy OBE, Chief Executive at the British Liver Trust said:
“If left undetected, the hepatitis B virus can cause liver damage and increase an individual’s risk of developing liver cancer, yet thousands of people in the UK are asymptomatic and unaware they are infected with it.
This latest research reinforces what we already knew – that opt-out testing is highly effective at identifying people living with previously undiagnosed blood borne viruses, such as hepatitis B and hepatitis C, so that they can receive treatment, prevent further complications and ultimately reduce NHS spending in the long term.”
In England alone, over 200,000 people are estimated to be living with chronic hepatitis B (HBV) – the majority are undiagnosed, unlinked to care and at higher risk of premature death from cirrhosis and liver cancer.
Professor Raj Mookerjee, Secretary of the British Association for the Study of the Liver said:
“The opt-out testing programme in Emergency Departments in England has identified an unprecedented number of new cases of hepatitis B, particularly from disadvantaged groups who are less likely to come forward for routine testing, and whose only interaction with healthcare services has been via emergency departments.
Although the surge in demand for services and access to treatment has added to NHS pressures, we must continue to work with policy makers to identify affected patients and address the health inequalities to ensure that everyone has access to the treatment and care that they need.”
Senior author of the research, Dr Kate Childs, King’s College Hospital NHS Foundation Trust said:
“This program has successfully identified a large number of patients with hepatitis B infection, who were either undiagnosed or not in care. Many of those tested live in areas of deprivation and have difficulty in accessing healthcare. This program empowers this group of individuals to attend for hepatitis B care, prevent onwards transmission and reduce the long-term risk of complications including liver cancer. Adequate resources are needed to ensure that hepatitis services are able to review and treat these patients in a timely manner.”
In November 2023, NHS England expanded the scope of opt-out testing for HIV and viral hepatitis in emergency departments to 47 sites across England. The British Liver Trust is calling for opt-out testing to be made routinely available across the UK.
(1) https://www.gov.uk/government/publications/bloodborne-viruses-opt-out-testing-in-emergency-departments
(2) https://www.gov.uk/government/publications/hepatitis-b-in-england
