Ten-Year Outcomes of Opt-Out Bloodborne Virus Screening in Urban ED
Overview
Over 10 years, an opt-out bloodborne virus (BBV) screening program in an urban emergency department (ED) demonstrated high patient acceptance (81%) and sustained detection of new BBV diagnoses. Linkage to care rates were excellent across HIV (96%), HBV (89%), and HCV (95%), with a significant reduction in PCR-positive HCV diagnoses observed.
Background
Bloodborne viruses such as HIV, hepatitis B (HBV), and hepatitis C (HCV) cause significant morbidity and mortality worldwide. Early diagnosis and treatment reduce disease burden and prevent transmission, yet many infected individuals remain undiagnosed. Emergency departments provide a unique opportunity for opportunistic BBV screening, especially using opt-out approaches that increase testing uptake among diverse and marginalized populations. This study evaluates a decade-long opt-out BBV screening initiative in a large urban ED, assessing acceptance, diagnostic yield, and linkage to care.
Data Highlights
Parameter
Value
Screening acceptance among phlebotomized patients
81%
Linkage to care rates
HIV: 96%, HBV: 89%, HCV: 95%
Trend in new BBV diagnoses
No significant change in HIV, HBV, HCV
Trend in PCR-positive HCV diagnoses
Significant reduction over 10 years
Association with PCR-positive HCV
People who inject drugs; discharged directly from ED
Key Findings
High acceptance of opt-out BBV screening in ED patients undergoing phlebotomy (81%).
Stable rates of new HIV, HBV, and HCV diagnoses over 10 years, but a significant decline in PCR-positive HCV cases.
Excellent linkage to care achieved: 96% for HIV, 89% for HBV, and 95% for HCV.
PCR-positive HCV infections were significantly associated with people who inject drugs and those discharged directly from the ED without admission.
The program successfully identifies active HCV infections in a high-risk population often missed by traditional care pathways.
The COVID-19 pandemic delayed interim program review but did not diminish overall screening effectiveness.
Clinical Implications
Opt-out BBV screening in emergency departments is a feasible and effective strategy to identify undiagnosed infections and ensure high linkage to care, particularly in socially deprived urban populations. Targeted efforts to engage people who inject drugs and those discharged directly from the ED may further improve detection of active HCV infections. Incorporating routine BBV screening into ED workflows can reduce barriers and stigma associated with testing.
Conclusion
A decade of opt-out BBV screening in an urban ED demonstrates sustained acceptability, consistent diagnostic yield, and high linkage to care, highlighting its value as a public health intervention. Continued adaptation of the program is needed to maintain and enhance detection, especially among high-risk groups.
References
St James's Hospital EDVS Program 2024 -- Ten-Year Results of an Opt-Out Bloodborne Virus Screening Initiative
