Testing for Hepatitis B and C virus and HIV in mental healthcare settings in England between 2015–2021

TL;DR

This study examines hepatitis B, hepatitis C, and HIV testing and treatment in mental healthcare settings in England from 2015 to 2021.

Contribution

The study identifies demographic associations with BBV positivity and treatment outcomes in mental health settings.

Findings

Testing positive for HBsAg, anti-HCV, and HIV was 1.1%, 4.3%, and 1.1% respectively.

Black ethnicity was associated with higher odds of HBsAg and HIV positivity.

Opt-out BBV testing may reduce health inequalities in mental health populations.

Abstract

People living with severe mental illness have an increased prevalence of bloodborne viruses (BBVs) such as hepatitis B (HBV) and hepatitis C viruses (HCV), and HIV. To help improve the physical health of people living with severe mental illness, we aim to understand associations with BBV testing and treatment provision among those tested in mental healthcare settings in England. HBV surface antigen [HBsAg], antibody HCV [anti-HCV] and HIV testing and demographic information pertaining to people tested in mental health settings in England were extracted from a BBV testing dataset. Records pertaining to individuals diagnosed with HCV or HIV were linked to treatment datasets. Multivariable logistic regression analyses were used to understand demographic associations with test positivity for each BBV. Between 2015–2021, 18,221 people tested for a BBV in a mental health setting (56% male, 71% White ethnicity), 90% of whom were in inpatient care. Testing positive for HBsAg, anti-HCV and HIV was 1.1% (95%CI: 0.93–1.26%), 4.3% (4.00–4.63%) and 1.1% (0.92–1.25%) respectively. In multivariable analyses, women had reduced odds of testing positive for anti-HCV and HIV compared to men. Being of Asian, Black, or another ethnicity was associated with increased odds of testing HBsAg positive and Black ethnicity was associated with a positive HIV test result compared to White ethnicity. White ethnicity was associated with testing anti-HCV test positive compared to all other ethnicities. Half (344/708) of those who were anti-HCV positive would have benefitted from treatment (HCV-RNA positive), of which 58% received treatment. HIV treatment (96%) and viral suppression (94%) after testing in mental healthcare was high. To improve the physical health of people living with mental health conditions and to aid England’s hepatitis elimination and HIV transmission goals, opt-out testing for BBVs may be beneficial to reduce health inequalities among people experiencing mental illness.

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