Hepatitis B and C testing

Short Text

Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection.

Introduction

This pathway aims to ensure more people at increased risk of hepatitis B and C infection are tested. It covers:
  • Awareness-raising among:
    • the general population
    • people at increased risk of hepatitis B and C infection.
  • Developing the knowledge and skills of healthcare professionals and others providing services for people at increased risk of hepatitis B or C infection.
  • Testing:
  • Contact tracing.
  • Providing and auditing neonatal hepatitis B vaccination.
  • Commissioning hepatitis B and C testing and treatment services.
  • Laboratory services for hepatitis B and C testing.
This pathway does not provide detail on treatments for hepatitis B or C.

Pre-requisites

The recommendations in this pathway are based on the assumption that hepatitis B and C tests are provided according to current best practice and are offered as part of a care pathway covering diagnosis, treatment and immunisation.

Testing

The recommendations assume that:
  • Testing facilities are equipped with sharps bins and follow advice on infection control and appropriate testing methods, particularly if testing is done outside healthcare settings.
  • People being tested for hepatitis B and C are offered pre- and post-test discussions (see 'Areas to consider when offering a test for hepatitis B or C' below).
  • Testing is undertaken with the person's consent.
  • Standards for local surveillance are followed, including laboratory reporting to Public Health England centres and follow-up of hepatitis B and C.
Areas to consider when offering a test for hepatitis B or C
  • Have issues of confidentiality and anxiety been addressed?
  • Has the offer been accompanied by an agreed mechanism for providing the result to the person being tested?
  • Has the offer been phrased in a way that suits the person's age, culture and literacy level and is respectful and non-judgemental?
  • Has the offer taken into account potential barriers to testing such as the stigma associated with hepatitis B and C or lack of access to services?
  • Has the offer included information to enable people to make informed choices about their care should they test positive, and to reduce their risk of hepatitis B and C infection should they test negative?
  • Has the offer been accompanied by details of support available for clinical and non-clinical needs, both while waiting for test results and following diagnosis?

Treatment

NICE has recommended a number of drugs to treat hepatitis B and C and also has clinical guidelines in development on the diagnosis and management of hepatitis B and C. Guidance on managing co-infection with HIV-1 and hepatitis B or C is available from the British HIV AssociationNICE has accredited the process used by the British HIV Association to produce UK national guidelines. Accreditation is valid for 5 years from 12 July 2012 and is applicable to guidance produced since 2011. The NICE Accreditation Scheme recognises organisations that demonstrate high standards in producing health or social care guidance. Users of the accredited guidance can therefore have high confidence in the quality of the information.. The European Association for the Study of the Liver (EASL)Guidance produced by EASL has not been reviewed by the NICE Accreditation Scheme. EASL guidelines may assist healthcare providers in the clinical decision-making process by describing a range of generally accepted approaches for diagnosing, treating and preventing hepatitis B and C. However, it should be ensured that action taken is in line with NICE guidance. has published best practice guidelines on managing hepatitis B and hepatitis C.

Immunisation

Guidance on hepatitis B vaccination is available in the Green book: immunisation against infectious diseases and the Hepatitis B antenatal screening and newborn immunisation programme, both published by the Department of Health, and in the NICE pathway on Reducing differences in the uptake of immunisations.

Source guidance

The NICE guidance that was used to create the pathway.

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Pathway information

Updates to this pathway

11 March 2014 Minor maintenance update.
26 November 2013 Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people (NICE technology appraisal guidance 300) added to related guidance.
5 July 2013 Minor maintenance update.
25 June 2013 A View Hepatitis B (chronic) pathway was added to the overview.
8 March 2013 Clarification on offering tests for hepatitis B and C in sexual health and genitourinary medicine clinics added to Testing in sexual health and genitourinary medicine clinics.
14 December 2012 Minor maintenance updates.

Supporting information

Whose health will benefit?

In the UK, the majority (95%) of new chronic hepatitis B infections occur in migrant populations, having been acquired perinatally in the country of birth. In contrast, approximately 90% of chronic hepatitis C infections are seen in people who inject drugs or have done so in the past.
Groups at increased risk of hepatitis B compared with the general UK population include:
  • People born or brought up in a country with an intermediate or high prevalence (2% or greater) of chronic hepatitis B. This includes all countries in Africa, Asia, the Caribbean, Central and South America, Eastern and Southern Europe, the Middle East and the Pacific islands.
  • Babies born to mothers infected with hepatitis B.
  • People who have ever injected drugs.
  • Men who have sex with men.
  • Anyone who has had unprotected sex, particularly:
    • people who have had multiple sexual partners
    • people reporting unprotected sexual contact in areas of intermediate and high prevalence
    • people presenting at sexual health and genitourinary medicine clinics
    • people diagnosed with a sexually transmitted disease
    • commercial sex workers.
  • Looked-after children and young people, including those living in care homes.
  • Prisoners, including young offenders.
  • Immigration detainees.
  • Close contacts of someone known to be chronically infected with hepatitis B.
For hepatitis C, groups at increased risk include:
  • People who have ever injected drugs.
  • People who received a blood transfusion before 1991 or blood products before 1986, when screening of blood donors for hepatitis C infection, or heat treatment for inactivation of viruses were introduced.
  • People born or brought up in a country with an intermediate or high prevalence (2% or greater) of chronic hepatitis C. For practical purposes this includes all countries in Africa, Asia, the Caribbean, Central and South America, Eastern and Southern Europe, the Middle East and the Pacific islands.
  • Babies born to mothers infected with hepatitis C.
  • Prisoners, including young offenders.
  • Looked-after children and young people, including those living in care homes.
  • People living in hostels for the homeless or sleeping on the streets.
  • HIV-positive men who have sex with men.
  • Close contacts of someone known to be chronically infected with hepatitis C.

Glossary

The people in close contact with someone infected with hepatitis B or C, where there is a risk of transmitting the infection (through blood or body fluids). This could include their family members, close friends, household contacts or sexual partners.
Continuation of treatment and referral for people moving in, out or between prisons.
In addition to housing people who remain in the UK illegally, immigration removal centres house people who are waiting for their immigration claims to be resolved or to have their identities established. Detainees are entitled to primary healthcare facilities during their stay, equivalent to those available in the community.
In addition to housing people who remain in the UK illegally, immigration removal centres house people who are waiting for their immigration claims to be resolved or to have their identities established. Detainees are entitled to primary healthcare facilities during their stay, equivalent to those available in the community.
A model of prison-based healthcare provision in which healthcare services are brought into the prison, instead of the prisoner being taken out to the healthcare service (for example, to a hospital outpatient unit).
A process that identifies the current and future health and wellbeing needs of a local population, leading to agreed commissioning priorities that aim to improve outcomes and reduce health inequalities.
Additional services provided by GPs, designed to meet specific local health needs.
A process to ensure prisoners are not transferred until they are medically fit.
Hepatitis B and C can be cleared by the body's own immune system. An antibody test determines whether a person has ever been infected with hepatitis in the past. If the test is positive further tests are carried out to establish whether the virus is still present in the body.
Peers are members of the target population who have been diagnosed with hepatitis B or C. They may be recruited and supported to communicate health messages, including promoting testing and treatment, assist with contact tracing or testing, and to offer people support during testing and treatment.
Polymerase chain reaction.
Her Majesty's prison establishments, including young offender institutions.
Her Majesty's prison establishments, including young offender institutions.
Intimate contact with others, including kissing and oral, anal, and vaginal intercourse. Hepatitis B is transmitted by direct contact with infected blood. However, it can also be transmitted by contact with semen, vaginal fluids and other body fluids. Hepatitis C is primarily transmitted by contact with infected blood.

Strategy, policy and commissioning on hepatitis B and C testing

View the 'Strategy, policy and commissioning on hepatitis B and C testing' path

Increasing the uptake of hepatitis B and C testing

View the 'Increasing the uptake of hepatitis B and C testing' path

Offering and providing hepatitis B and C tests and hepatitis B vaccination

View the 'Offering and providing hepatitis B and C tests and hepatitis B vaccination' path

Hepatitis B (chronic) pathway

View the 'Hepatitis B (chronic) overview' path

Paths in this pathway

Pathway created: December 2012 Last updated: March 2014

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