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HBV / HCV Screening. Hep C U Later programme

  

Which asymptomatic patients need screening for HBV and HCV? Details of the NHSE Hep C U Later programme


Hepatitis B & C

Please click on the link below to get an up-to-date guidance on this topic.

If there are any concerns/difficulties in interpreting the results, please phone the clinical virology team, who will be happy to help. Tel: 024 7696 4640; 024 7696 5473 or 5471.

Screening of asymptomatic patients for HBV and HCV

The following groups, and their contacts, are at high risk for HBV and/or HCV and should be offered testing routinely.

  • Immigrant detainees / origin from high prevalence countries (Africa, Asia, South/Eastern Europe, Middle East, Central/South America, Pacific Islands)
  • Babies of HB/HC mothers
  • Current or past recreational drug use
  • Homeless, living in hostel
  • Prisoners, young offenders
  • Looked after children and young people
  • Close contacts of known HB/HCV sufferer
  • MSM
  • Multiple sexual partners
  • Commercial sex workers
  • Blood transfusion < 1991; blood products < 1986

Note: refer symptomatic patients with jaundice or ascites to an acute jaundice clinic.

Examination:

  • Ascites or Jaundice
  • Enlarged liver and/or spleen

Blood tests:

The screening test for HBV is Hepatitis B Surface Antigen.

If this is positive the laboratory will do further tests to

(a) determine if infection is acute or chronic

(b) determine ‘e’ antigen status.

The screening test for HCV is Hepatitis C antibody.

If this is positive the laboratory will ‘reflex’ test for HCV RNA to decide between past or current infection, or request a further sample if insufficient sample available to complete testing.

Consider screening for HIV

Many high risk patients will also be at high risk for HIV and offering an HIV test is advised

Confirmed HBV or HCV infection

Refer to secondary care specialist

All patients positive for Hepatitis B surface antigen should be referred.

For hepatitis C, only refer patients if the HCV RNA is positive, not HCV antibody positive RNA negative patients.

Reassure HCV RNA negative patients that they do not have on-going HCV infection.

Positive antibody results are either due to past infection or non-specific reactivity in the screening test.

If there are any concerns/difficulties in interpreting the results please phone the Clinical Virology team who will be happy to help:

Virology Consultant Virologist/Clinical Lead Virology and Molecular Pathology  Ext: 25340 Virology Clinical Scientist(s)  Ext: 25471/25349

Referral information should include: medical history, mental health history, risk factors history, alcohol / substance misuse, sexual history

Notification – Inform Public Health England

See Notification of Infectious diseases

Further action in primary care

High risk patients may have on-going risk of acquiring infection (eg if current drug use etc) so it is worthwhile starting a HBV vaccination course after 1st bloods taken.

If the result comes back as positive for HBV infection then further vaccination is unnecessary – but no harm will have been done. If negative for HBV then complete the course.

If a patient is confirmed as having HCV infection then avoiding acquisition of HBV is particularly important, so offer patients with HCV infection vaccination against HBV infection if this has not already been done.

For confirmed cases of HBV infection offer HBV vaccination to close contacts / sexual partners / family members / household contacts.

Refer to Immunisation Against Disease (The Green Book)

Offer advice regarding prevention of onward transmission e.g. safe sex, donating blood, needle sharing.

Request ‘New Liver Patient’ screen, and state on form that patient has newly diagnosed HBV or HCV. This profile will help the hepatologist make best use of the first out-patient appointment.

The panel is: A1 antitrypsin, liver/kidney antibodies, auto-antibody screen, alphafetoprotein, FBC, ferritin, gamma GT, glucose, immunoglobulins, INR, LFTs, U&Es. Please do not request this profile until the diagnosis of HBV or HCV is made.

For HBV positive patients it is also helpful to the hepatologist, but not essential, if an HBV viral load (3 x EDTA blood bottles) is requested, so that this result is available for the first out-patient visit.

For either HBV or HCV positive patients please offer an HIV test if not already done

Hep C U Later Programme – new resources to help eliminate hepatitis C from Hep C U Later

 

Hep C U Later has been commissioned by NHS England to provide you with the resources to help encourage testing amongst patients, to provide information to the public and update knowledge amongst you and your teams

NHS England’s successful national elimination programme for hepatitis C has so far seen over 80,000 people found and treated through extensive work within drug and alcohol services and other areas of healthcare such as emergency departments

 

The elimination programme is now seeking to find the estimated 70,000 remaining people believed to be living with hepatitis C.

Risk factors for Hepatitis C can include:

  • Sharing equipment for injecting drugs
  • Having a blood transfusion prior to Sept 1991
  • Had a piercing, tattoo, or acupuncture using unsterilised equipment

Amongst the resources available to you are:

CPD accredited hepatitis C training module – free to access

National Testing Portal Poster – advertising the free, confidential at home testing kits, available to anyone in England

Information Leaflets – for your community to understand the virus, the treatment and support

Primary Care Toolkit – detailing everything from NICE guidelines to testing methods and treatment

Additionally, follow the Hep C U Later LinkedIn page or take a look at the website  – www.hepculater.com

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