Opt-out testing for blood-borne viruses in primary care: a multicentre, prospective study.

Abstract

BACKGROUND: Hepatitis B (HBV), hepatitis C (HCV), and HIV blood-borne viruses (BBV) are associated with chronic ill health and mortality. Early diagnosis reduces disease transmission, delays progression, and improves outcomes. Routine opt-out testing for BBV in primary care may be viable in identifying unknown disease. AIM: To assess the viability and yield of routine opt-out testing for BBV. DESIGN AND SETTING: A multicentre, prospective, routine opt-out testing study of BBV in primary care between September 2014 and February 2015 across four sites in Dublin, Ireland. METHOD: All adult patients attending for routine blood tests were offered an additional BBV test during a 6-month period. All individuals were given an information leaflet before phlebotomy and were given the choice to opt out of BBV testing. RESULTS: In total, 1188 patients were invited to participate in the study and 1063 (89.5%) opted to be tested (95% confidence interval [CI] = 87.7% to 91.2%). A total of 125 patients (10.5%) opted out. There were 10 positive results, four new diagnoses, and six previously known. There were two new HBV and two new HCV diagnoses, a yield of four per 1000 (95% CI = 0.9 to 7.5 cases per 1000). No new HIV cases were diagnosed. CONCLUSION: This study indicates that testing for BBV in patients presenting for routine blood tests in primary care is viable. The yield of HBV and HCV suggests that opt-out testing should be considered in primary care to increase detection rates of BBV.