# Universal opt-in HIV, HBV and HCV testing in an emergency department: implementation and outcomes of a comprehensive screening program

## TL;DR

This study evaluated a voluntary blood-borne virus screening program in an emergency department, finding it identified undiagnosed infections but faced challenges in participation and connecting patients to care.

## Contribution

The study presents a real-world implementation of opt-in BBV screening in an urban ED and evaluates its effectiveness and barriers.

## Key findings

- 3.2% of tested individuals had at least one blood-borne virus infection.
- Linkage to care was successful in less than half of newly diagnosed HIV cases.
- Homelessness and lack of health insurance were major barriers to care linkage.

## Abstract

To evaluate a Blood Born Virus (BBV) infection screening program in an emergency department (ED) located in an urban setting with an intermediate prevalence of undiagnosed BBV infections.

The program in the ED of the St. Joseph Hospital, Berlin, Germany, was active from June 2021 through April 2024. Patients aged 18–68 undergoing routine blood sampling were eligible for opt-in screening. We analyzed testing uptake, temporal trends, positivity rates, and linkage to care.

A total of 23,118 cases were eligible for testing. Screening was offered to 2670 cases (11.5%). 2440 (91.4%) consented of whom 2406 were tested. Testing volumes remained below 11% of the eligible population.

Among 2406 cases, 78 (3.2%) individuals were found to have at least one BBV infection.

HIV infection was detected in 36 (1.5%) individuals. 12 individuals (0.5%) had previously undiagnosed HIV infection (median [range] CD4 count: 213/µL [66–794]). Linkage to care was successful in 50.0%.

HBV was found in 16 (0.7%) individuals, with 6 (0.2%) previously undiagnosed individuals; linkage to care was achieved in 33.3%.

HCV was confirmed in 38 (1.6%) individuals, including 13 (0.5%) previously undiagnosed individuals; linkage to care was achieved in 15.4%.

Homelessness, substance use, and lack of health insurance coverage were key barriers to successful linkage.

Universal BBV testing in an urban ED proved effective in identifying previously undiagnosed infections. However, due to its opt-in design, the program operated below its potential capacity. Linkage to care was often unsuccessful, largely due to structural barriers.