1. HCV Testing trends

2. General remarks on HCV testing Trends in HCV testing in NI – An 11 year dataset RAGS- blood lab initiative- 2011-2012

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

4. ` 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 ?

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

6. 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

7. 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

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

11. 9.6% of HCV tests

13. 15.4% Of HCV tests

14. 5.2% of HCV tests

15. 25.6 % of HCV tests

16. 0.49 % of HCV tests

17. 0.39 % of HCV tests

18. SourcetestedPositive% positive Belfast10503190.18 Northern232460.26 Southern198290.45 South Eastern147750.34 Western410240.1 GP4282330.77 Other128130.23 TOTAL25951790.3 2010 Positive results Trust/GP

19. SourcetestedPositive% positive OCCUPATIONAL HEALTH210330.14 Fertility134400 GUM6632140.21 ADDICTION12732.4 RENAL398700 Prison10122 2010 Positive results -Specialty

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

21. Virology testing in NI Blood lab initiative (2011 2012) Biochemistry Haematology Immunology Microbiology serology (including Virology) Molecular

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