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Theme B: Project 3: Assessing the feasibility of testing for BBVs in AE
The aim of this project is to assess the feasibility of introducing routine testing for BBVs in Accident and Emergency (A&E) departments.
This will be achieved through assessing best models of practice derived from evidence reviews, qualitative and seroprevalence studies. A systematic review will be conducted to identify best practice models to achieve effective provision of diagnostic testing for BBV in A&E and other urgent care settings. We will perform unlinked anonymous testing (UAT) of residual blood samples obtained from 5000 A&E attendees at 2- 3 hospitals selected by indices of deprivation and ethnic diversity in order to estimate the prevalence of HCV, HBV and HIV amongst A&E attendees.
Samples will be screened for BBV serological makers (HIV: HIV Ag/Ab; HBV: HBsAg and total anti-HBc; HCV: anti-HCV) and reactive samples will be confirmed. Molecular characterisation studies will determine viral load, genotype distribution, clinically significant mutations and phylogeny.
Comprehensive molecular and phylogenetic characterization of BBVs in the infected A&E population will inform contact tracing, control strategies, and an evidence-based model of provision of diagnostic testing for BBV in A&E. Estimates from the seroprevalence and molecular characterisation will also inform the Cascade of Care (CoC) models to be developed in Theme C.
Qualitative methods will be used to explore barriers and facilitators, feasibility and acceptability to BBV testing in A&E from the patient and provider perspective. Following synthesis of the evidence from the review, qualitative methods and the seroprevalence study, we will develop a model of universal opt-out testing for BBV in A&E and will conduct a pilot study to assess the feasibility of implementing this model in practice.