Pathway for Going Viral week

Transcription

1 Pathway for Going Viral week Going Viral Lead: Dr Chloe Orkin Infection & Immunity (ECAM) BBV Testing Facilitator Dr Emma Wallis On Call HIV SpR (Mon-Fri 9-5) Out of hours: via switchboard Deputy Head of Health Advising Samantha Gilliham x Fax x Going Viral Week - summary Infection and Immunity (I&I) will offer universal testing for the bloodborne viruses (BBVs) HIV, Hepatitis C and Hepatitis B to all Emergency Department (ED) attendees already having venepuncture during Going Viral week. Universal BBV testing will be extensively signposted on banners, posters and information throughout ED. It will also be advertised through the Trust website and social media. BBV screening is for all three viruses (HIV, Hepatitis B and Hepatitis C). Patients must accept the full BBV screen (all three viruses) to be part of this campaign. Attendees may opt out if they wish. Based on past campaigns, most ED attendees will wish to test. Please use FAQs below to address any questions about testing. Virology staff will provide a list of positive BBV results to the BBV Testing Facilitator each day by means of a failsafe database. Results will take about 72 hours to come back. The ED team is not responsible for giving BBV results, for contact tracing, nor for linking patients to care. The Infection and Immunity team will action positive results. Patients will be told we will use a no news is good news approach to negative results. 1

2 If the patient is an inpatient the BBV facilitator will liaise with the team of care. If the patient is at home the BBV Testing Facilitator arrange follow up with the GUM clinic, GP or Hepatitis clinic as per national guidance and local policy. The cost of the tests will be entirely met by the campaign funds. ED will not pay for the BBV tests. 2

3 Patient pathway 1. Why should we offer BBV testing? East London sees amongst the highest prevalence rates in the UK for each virus. At least 50% of those who are HIV, Hepatitis C and B positive are diagnosed late, which delays access to treatment. Many people are not being tested prior to symptoms emerging. These statistics suggest that we need to be doing more to encourage individuals who are unknowingly living with these viruses to be tested. Testing for HIV, Hepatitis B and Hepatitis C is the key to preventing their spread. 2. Can these BBV s be treated? There are excellent treatment options for all three viruses which are highly successful in preventing illness and death. These are: HIV: Anti-retroviral medications are able to control the virus and restore a near-normal life expectancy for patients diagnosed early Hep B: Excellent anti-viral medications are able to control the virus and stop the liver stiffness from progressing Hep C: new anti-viral medications targeting the Hepatitis C virus are able to cure a very high percentage of patients in those that need them (>80%) 3. How to offer BBV testing Any health professional can offer BBV testing in the same way that they currently do for any other medical investigation (British HIV Association 2008). Within a campaign where posters, banners and materials are on display advising patients of opt-out testing, no written informed consent is needed. Advise the patient that they are being offered BBV testing because of high rates in east London and that it is important for everyone to know their status to prevent serious future illness. Examples of what to say to your patients: This week we are testing everyone who comes to the Emergency Department for HIV, Hepatitis B and C in keeping with national guidelines. Is that ok? As you re having a blood test to look at how your liver and kidneys are working, we d also like to screen for infections including HIV and Hepatitis. Is that OK? 3

4 4. Take the blood Order HIV 1 & 2 antibody test, Hepatitis B surface antigen and Hepatitis C antibody on CRS. Send 10ml clotted blood with request (yellow top bottle). If for any reason you feel the test should be done urgently, please arrange directly with virology as per your normal practise Document on discharge summary on CRS if BBV testing declined 5. Results The ED team is not responsible for giving results All positive results will be identified through a failsafe database sent by virology staff to the BBV testing facilitator each day The BBV facilitator will receive results within 72 hours of receipt in the lab. Negative results are likely to be quicker. For inpatients, the Infection and Immunity team will communicate any positive results to the team looking after the patient. The BBV testing facilitator will support the team if needed in giving the result. If the patient has been discharged home: Negative BBV results; no news is good news ie the patient will not be contacted regarding the result. Positive BBV result; the BBV Testing Facilitator will recall and arrange follow up with local services as per national guidelines. Patient information in the ED will mention the three month window period for testing. Patients who consent for BBV testing must have the tests done. If for any reason they are not tested they must be informed of this. 4

5 BBV Testing flowchart Patient consents BBV test offered Patient declines Blood for HIV 1&2 antibody, Hepatitis B sag & Hepatitis C Ab sent to virology lab Risk factors explained, advised to test via GP NEGATIVE BBV RESULT POSITIVE BBV RESULT Patient informed by ward team If already discharged then no news is good news Patient on ward BBV Testing Facilitator informs ward team and also HIV and/or Hepatitis Team as relevant Patient discharged BBV Testing Facilitator contacts patient and arranges appointment at local clinic 5

6 Frequently Asked Questions (FAQs) about HIV - for patients Facts about HIV HIV is a virus that attacks the immune system the body s defence against diseases Having HIV does not automatically mean that you have AIDS There are very effective treatments available for HIV, although there still is no cure If HIV is diagnosed and treated early enough, in the UK, life expectancy is near normal for most people. Why screen for HIV in Emergency Departments? In east London more than six people in 1000 have HIV infection. Around a quarter of these people do not know that they have the virus. Around 50% of people are diagnosed late; this means that treatment is delayed and may not be as effective. We already routinely screen for HIV in many parts of the hospital such as antenatal clinics, intensive care and the medical admissions unit. This week we are also screening in our Emergency Department for HIV, Hepatitis B and C. How will I get my results? If your test shows that you don t have HIV, we adopt a no news is good news policy. This means that we won t be in contact with you. If your test shows that you do have HIV, we will contact you once we have the results and ask you to come in and see us to plan your treatment. What does a negative result mean? This means that you do not have HIV infection. This is reassuring and means that you can continue to take steps to prevent HIV infection such as using condoms. It can take up to three months for HIV to show up on some blood tests. Therefore, if you may have been exposed to HIV infection in the last three months you should test again three months from your last risk eg through unprotected sex - your GP or a sexual health clinic can do this. Will having a negative HIV test result stop me getting life insurance? No. The Association of British Insurers (ABI) have told insurance companies that a negative HIV test result must not affect people s rights to insurance. Insurance companies have been told they are not to ask GPs if an applicant has ever had an HIV test. Can I have written confirmation of my result? You may ask your GP as for any other medical report request. You should be aware that GPs will most likely make a charge for this service. 6

7 What does a positive result mean? This means you DO have HIV infection, but does NOT automatically mean you have AIDS. If your HIV test result shows you do have HIV: there are excellent treatments that now allow patients to live a nearnormal life-expectancy without becoming ill with HIV-related diseases you may take steps to avoid passing HIV on to your sexual partners What happens next if I receive a positive HIV result? We will refer you to be seen by a specialist HIV team within two weeks for an initial assessment. They will do some blood tests to find out if you need treatment at this stage. What about telling my family? The general rule is that all medical information is confidential to you, so it is up to you to decide whom you tell about your HIV test result. If you want support in telling your family about your HIV status so that they can also be treated if they need it, the HIV team are very experienced in advising you. Will my family or friends get HIV from me? There is no risk of passing HIV to your family or other people through regular household and social contact like hugging, kissing and sharing cups or plates. However, it can be passed sexually so we advise using condoms. The HIV team can provide more information about transmission. Will my partner or my children have to be tested? The HIV team will advise you on this because HIV can be passed on from mother to child during pregnancy and delivery. We will work with you and help to arrange to get your partner and/or children tested if this is needed. Will I have to tell my employer if I am HIV positive? Once again, the HIV team will be able to advise you fully on this. There is no law that requires you to tell your employer that you have HIV, people living with HIV work safely in all sorts of jobs including the health service. For some occupations, eg in certain healthcare settings it may be helpful to discuss your status with occupational health. Will my GP be informed of a positive HIV test result? If your HIV test is positive, we believe it is best for you to inform your GP because: they provide your general out-of-hours and emergency care they will know to look out for any HIV related problems which could otherwise be missed However, it is not essential to tell your GP and some people still choose not to, particularly when they are first diagnosed. 7

8 What about mortgages or insurance? Many companies provide repayment mortgages for people with a range of long-term or serious medical conditions like diabetes or cancer and HIV. For someone who already has life insurance and is diagnosed with HIV, the guidance states Existing life insurance policies will not be affected in any way by taking an HIV test, even if the result is positive. Further reading MedFASH Patients FAQ about HIV testing BHIVA UK National Guidelines for HIV Testing 2008 Useful websites 8

9 Frequently Asked Questions (FAQs) about Hepatitis B testing for patients Facts about Hepatitis B Hepatitis B is a virus that is carried in the blood and can cause serious damage to the liver It s mainly spread through contact with the blood of an infected person, unprotected sex, sharing works during injecting drugs or from an infected mother to her baby during delivery Most people are able to fight off Hepatitis B infection and clear the virus naturally. This may take up to six months. Some people do not clear the virus and develop a longstanding infection leading to liver stiffness. People with longstanding Hepatitis B infection remain infectious to other people. Excellent anti-viral medications are able to control Hepatitis B and stop the liver stiffness from progressing. The infection can be prevented with a safe and effective vaccine. In some parts of the world such as South Asia, people may be at risk when getting medical treatment (if instruments are not sterile), when having a haircut, a shave or when getting a piercing Why screen for Hepatitis B in Emergency Departments? Around 50% of people with Hepatitis B in east London are diagnosed late; this means that treatment is delayed and may not be as effective. National guidance is aiming to increase Hepatitis B testing; this week we are screening in Emergency Departments for HIV, Hepatitis B & C. How will I get the result? If your test shows that you don t have Hepatitis B, we adopt a no news is good news policy. This means that we won t be in contact with you. If you have Hepatitis B, we will contact you once we know you have Hepatitis B and ask you to come in and see us in clinic. What does a negative Hepatitis B test result mean? This means that you do NOT have Hepatitis B. However, if you think you have been exposed to Hepatitis B in the past three months, it may not show on today s test and you should retest at your GP or sexual health clinic three months from your last risk Can I have written confirmation of my result? You may ask your GP as for any other medical report request. You should be aware that GPs will most likely make a charge for this service. What does a positive result mean? This means you DO have Hepatitis B infection. If you get a positive Hepatitis B test result: 9

10 Treatment is not always needed, however you will need to be monitored regularly. There are effective treatments which can keep the virus under control and slow progression of liver stiffness. What happens next if I have a positive result? We will ask you to be seen by your GP, sexual health clinic or Hepatitis nurse specialist for an initial assessment as indicated by your test results. They will arrange follow up with the Liver (Hepatology) team as required. What about telling my family? The general rule is that all medical information is confidential to you, so it is up to you to decide whom to tell about a positive Hepatitis B test result. If you would like our support in telling your family about your Hepatitis B status, the Hepatitis team help as they have experience in doing this. Will my family or friends get Hepatitis B from me? You cannot infect your family and friends through everyday activities, such as sharing cups and plates, hugging or kissing. To avoid infecting others, Do not share items such as toothbrushes or razors Clean up any blood spills with diluted bleach Do not share any drug taking equipment (eg tooters, needles and syringes, water or cookers etc). Use condoms for sex, especially until your partner has been successfully vaccinated Will my partner or my children have to be tested? The Hepatitis team will advise you on this and will help to arrange to get your partner and/or family tested if it is necessary. If your partner/family are not infected, then they can be offered vaccination to prevent Hepatitis B. Will I have to tell my employer if I have Hepatitis B? Once again, the Hepatitis team will be able to advise you fully on this. There is no law that requires you to tell your employer that you have Hepatitis B. For some occupations, eg in certain healthcare settings, there may be a restriction on what you can do so that the risk of passing on Hepatitis B to patients is avoided. This is specialist area and there is specialist advice available for those who are healthcare workers. Will my GP be informed of a positive Hepatitis B test result? If your Hepatitis test is positive, we believe it is best to inform your GP because: they provide your general, out-of-hours and emergency care they need to know if you have a condition that affects your liver when they give you medications 10

11 What about mortgages or insurance? Many companies provide repayment mortgages for people with a range of long-term medical conditions like diabetes, cancer or Hepatitis B. If you have an existing life insurance policy, it is likely you will need to tell the insurer about a change in your health status as you would with any new health problem. Further reading Hepatitis B Foundation Fast Facts Useful websites British Liver Trust Virology and antibodies 11

12 Frequently Asked Questions (FAQs) about Hepatitis C testing for patients Facts about Hepatitis C Hepatitis C is a virus that is carried in the blood and can cause serious damage to the liver. It s mainly spread through contact with the blood of an infected person. If you are from South Asia, you can avoid exposure by being more careful when getting medical treatment, going for a haircut, a shave or getting a piercing when you re visiting home. Not sharing needles or works during injecting drug use will reduce your risk of getting infected. In most people infected with Hepatitis C, the virus will develop into long-term (chronic) infection. If you do have Hepatitis C you can be treated. Very effective treatment is available and can successfully clear the virus in as many as eight out of ten people. Why screen for Hepatitis C in Emergency Departments? Around 50% of people with Hepatitis C in east London are diagnosed late; this means that treatment is delayed and may not be as effective. National guidance is aiming to increase Hepatitis C testing; this week we are screening in Emergency Departments for HIV, Hepatitis B and C. How will I get the result? If your test shows that you don t have Hepatitis C, we adopt a no news is good news policy. This means that we won t be in contact with you. If you have Hepatitis C, we will contact you once we know you have Hepatitis C and ask you to come in and see us in clinic. What does a negative Hepatitis C test result mean? This means that you do NOT have Hepatitis C However, if you think you have been exposed to Hepatitis C in the past three months, it may not show on today s test and you should retest at your GP or sexual health clinic three months from your last risk. Can I have written confirmation of my result? You may ask your GP as for any other medical report request. You should be aware that GPs will most likely make a charge for this service. What does a positive result mean? This means you DO have Hepatitis C infection. If you get a positive HCV test result: There are very effective treatments that can cure Hepatitis C It is better to plan HCV treatment to start before the liver is damaged What happens next if I have a positive result? We will ask you to be seen by your GP, sexual health clinic or Hepatitis nurse specialist for an initial assessment as indicated by your test results. They will arrange follow up with the Liver (Hepatology) team as required. 12

13 What about telling my family? The general rule is that all medical information is confidential to you, so it is up to you to decide who to tell about a positive Hepatitis C test result and we will not inform anyone of the result unless you ask us to. If you want support in telling your family about your Hepatitis C status, the Hepatitis team can advise you as they have experience in doing this. Will my family or friends get Hepatitis C from me? You cannot infect your family and friends through everyday activities, such as sharing utensils, hugging or kissing. To avoid infecting others, Do not share items such as toothbrushes or razors Clean up any blood spills with diluted bleach Do not share any drug taking equipment (eg tooters, needles and syringes, water or cookers etc). The risk of sexual transmission is very low unless There is bleeding during or as a result of sex There are ulcers or sores on your private parts Will my partner or my children have to be tested? The Hepatitis team will advise you on this and will help to arrange to get your partner and/or family tested if it is necessary. Will I have to tell my employer if I have Hepatitis C? Once again, the Hepatitis team will be able to advise you fully on this. There is no law that requires you to tell your employer that you have Hepatitis C. For some occupations, eg in certain healthcare settings, there may be a restriction on what you can do so that the risk of passing on Hepatitis C to patients is avoided. This is specialist area and there is specialist advice available for those who are healthcare workers. Will my GP be informed of a positive Hepatitis C test result? If your Hepatitis test is positive, we believe it is best to inform your GP because: they provide your general, out-of-hours and emergency care they need to know if you have a condition that affects your liver when they give you medications What about mortgages or insurance? Many companies provide repayment mortgages for people with a range of long-term medical problems like diabetes or Hepatitis C. These medical conditions will also be taken into account when taking out life insurance. Further reading Hep C Trust information and resources relating to Hepatitis C 13

14 Useful websites Hepatitis C Factsheet NHS Choices - information on hepatitis C Information about hepatitis C for patients and carers References Public Health England, Review of HIV epidemiology in London. Public Health England Field Epidemiology Services (Victoria Office). November 2013 British HIV Association, British Association of Sexual Health and HIV, British Infection Society. Joint UK National Guidelines for HIV Testing 2008: BHIVA Public Health England, Diagnosed HIV prevalence in Local Authorities in England by PHE Centre Data for 2012 Hep C Trust information and resources relating to Hepatitis C WHO Hepatitis C Factsheet NHS Choices - information on hepatitis C Information about hepatitis C for patients and carers Hepatitis B Foundation Fast Facts British Liver Trust Virology and antibodies 14