OPEN Research Support
head

Chief Physician
Anne Øvrehus
Department of Infectious Diseases, Odense University Hospital


Projekt styring
Projekt status    Sampling ongoing
 
Data indsamlingsdatoer
Start 19.02.2020  
Slut 30.06.2021  
 



Emergency Room Testing for Hepatitis C as an intervention in the C-Free-South Project

Short summary

There are approximately 3500-4000 cases of hepatitis C in the Region of Southern Denmark, and up to half of these are undiagnosed. This project is a pilot study which aims to explore the feasibility of a risk-based testing offer for hepatitis C in patients utilizing emergency room services for other health concerns.  Furthermore, the study will assess linkage to treatment rates of patients diagnosed with an active hepatitis C infection during the study. This study is part of the C-Free-South initiative, an ongoing multi-level interventional study with the overall aim to achieve the WHO elimination target for hepatitis C in the Region of Southern Denmark (RSD). 


Rationale

Hepatitis C affects about 0.4 % of the adult population in Denmark. This equals roughly 3500-4000 HCV cases in the Region of Southern Denmark. Among diagnosed patients, up to 85% are current or former drug users. The remaining are infected nosocomially, by mother to child transmission, or sexually; this population includes migrants from countries with a high prevalence. The highest prevalence is in persons born 1945-1975, based on reported cases to the national authorities. In 2007 it was estimated that half of the HCV cases were undiagnosed. This is likely to have decreased in recent years due to better test-uptake in the prison and drug treatment setting in the region, but recent research has shown that only persons entering drug treatment programs, including opiate substitution therapy, have a test uptake of more than 50%. The awareness in the general population of hepatitis C is very low and even persons with cirrhosis aren't frequently tested. 

Studies from other countries have shown that persons attending emergency rooms and psychiatric facilities have a higher prevalence of HCV than in the general population. In 2003-2012, 3,8% of needle stick injuries at Odense University hospital were anti- HCV/HCV-RNA positive. 

The C-Free-South program aims to eliminate Hepatitis C in RSD. Diagnosing the undiagnosed not attending drug treatment is one of four interventions in the C-Free-South program.

Aims of the project

1. Describe prevalence of diagnosed and undiagnosed Hepatitis C infection in persons utilizing emergency medical services in the Region of Southern Denmark 

2. Evaluate risk factors for diagnosed and undiagnosed Hepatitis C infection 

3. To assess the feasibility of Hepatitis C screening in Emergency rooms 

4. Evaluate if patients diagnosed or re-engaged in care at the Emergency room will initiate treatment for hepatitis C 

Hypothesis 

Risk based screening at emergency medical services can identify patients exposed to hepatitis C, diagnose patients not previously diagnosed and (re-)engage people diagnosed in care and treatment.



Description of the cohort

The data collection will be conducted at the Emergency Room (Fælles Akutmodtagelse) at Odense University Hospital (OUH). During a period of 12 weeks, for 5 days each week, eligible persons aged 18-80 admitted to FAM at OUH will be offered a survey to evaluate their risk for hepatitis C within the first day of admission. If they fulfill any of the risk factors in the survey, they will be offered a point-of-care test for hepatitis C antibodies. Patients who are antibody positive will be offered confirmatory testing, and should an active hepatitis C infection be shown, will be referred to treatment at the Department of Infectious Diseases at OUH. 


Data and biological material

-Demographic data on patients, provided by the emergency room staff

-Self-reported data from the patient including survey answers and known details about hepatitis C infection where relevant

-Patient journal information where relevant

-Biological test data where relevant, including finger-prick blood samples and venous blood samples.



Collaborating researchers and departments

Department of Infectious Diseases, Odense University Hospital 

  • Professor, Chief Physician, PhD, Peer Brehm Christensen
  • MD, PhD student, Sandra Dröse
  • Pre-graduate Medical Student, SDU, Jessica Jennifer Wentworth

Emergency Department, Odense University Hospital

  • Senior Resident, Peter Biesenbach