HCV Testing trends

General remarks on HCV testing Trends in HCV testing in NI – An 11 year dataset RAGS- blood lab initiative

HCV infections 80% develop chronic infection 20% clear infection `

` Antibody positive PCR positive Antibody positive high level PCR negative ` Antibody positive low level PCR negative Current infection Past infection Past infection OR Spurious antibody ?

HCV Antibody tests are less perfect than HIV tests Low antibody positive PCR negative ?past infection Or ?Spurious E.g fertility occ health etc

Screening EIA (Abbott Architect) NegativeReactive <3 Reactive >3 Report: Negative Monolisa Ag/Ab NegativePositive HCV Antigen Report: Negative Report: No current infection. Either past infection or false positive antibody. Monolisa Ag/Ab NegativePositive Report: Current infection. Ask for second specimen for PCR & genotype. Suggest referral. See next slide

Screening EIA (Abbott Architect) Reactive >3 Monolisa Ag/Ab Positive PCR NegativePositive Negative Report: Negative Report: Current infection. Ask for second specimen for PCR & genotype. Suggest referral. Report: No current infection. Indicates past infection. Ask for second specimen

An estimated five out of every six UK people with chronic HCV are unaware of their infection. (2004) Diagnosed Undiagnosed

9.6% of HCV tests

15.4% Of HCV tests

5.2% of HCV tests

25.6 % of HCV tests

0.49 % of HCV tests

0.39 % of HCV tests

SourcetestedPositive% positive Belfast Northern Southern South Eastern Western GP Other TOTAL Positive results Trust/GP

SourcetestedPositive% positive OCCUPATIONAL HEALTH Fertility GUM ADDICTION RENAL Prison Positive results -Specialty

Trust positivity rate – 0.21% GP positivity rate – 0.77% Addiction positivity rate – 2.4% Prison positivity rate – 2.0%

Virology testing in NI Blood lab initiative ( ) Biochemistry Haematology Immunology Microbiology serology (including Virology) Molecular

The blood lab: RAGS Short term – Uncertainty – Diffs Longer term – Sustains virology molecular – Better TAT – Scaleable