HCV Testing trends

1. HCVTesting trends

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

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

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

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) Negative Reactive <3 Reactive >3 Monolisa Ag/Ab Monolisa Ag/Ab Negative Positive See next slide HCV Antigen Negative Positive Report: No current infection. Either past infection or false positive antibody. Report: Current infection. Ask for second specimenfor PCR & genotype. Suggest referral. Report: Negative Report: Negative

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

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. 2010 Positive results Trust/GP

19. 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