Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of
hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence
of clinically significant mutations which impact on treatment and control.
Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency
departments (ED) potentially effective at reaching vulnerable and underserved populations.
We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples
from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH)
or the University College London Hospital (UCLH) ED between January and June 2015 were
tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg.
PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were
1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA,
and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of
black vs. white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV
positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity
was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95%
CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity
was more likely among 36–55 year olds vs. ⩾56 years (7.69, 95% CI 2.24–26.41), and less likely
among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely
to be of black vs. white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED
attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness