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Friday 11th October 2024

Latest data reinforces calls for extension of opt-out hepatitis B testing and highlights need to resolve inequalities

New data presented today at The British Association for the Study of the Liver Annual Meeting in Harrogate has added weight to calls from the British Liver Trust for opt out blood testing to be made routinely available in all emergency departments across the UK. The research also highlights the urgent need for improvements to ensure adequate follow up and monitoring of patients who have been diagnosed with hepatitis B (HBV).

The British Liver Trust has been calling for the roll out of opt-out testing across all emergency Departments in the UK since testing for HIV, hepatitis B and hepatitis C launched in April 2022 in Emergency Departments in areas of very high HIV diagnosed prevalence. All Emergency Department attendees over 18 years of age who were having blood tests done for any reason, were tested for HIV, hepatitis B and hepatitis C, unless they opted out. The initiative has unearthed a lot more cases of undetected hepatitis B than expected, resulting in a 30% increase in estimated prevalence and surge in demand for hepatitis B services.

Opt-out blood borne virus testing in Emergency departments was rolled out in areas of extremely high HIV prevalence in April 2022. This research described the cases identified through testing at two Emergency Departments in King’s College Hospital NHS Foundation Trust. In the first 18 months, out of the 837 patients who tested positive for viral hepatitis (hepatitis B or C), the majority, 715 (85%) tested positive for hepatitis B. Although 351 (42%) were already in care, almost a quarter (24%) were new diagnoses of hepatitis B, which can cause liver fibrosis, cirrhosis and liver cancer and other serious health complications if left untreated.

56 patients (8%) had previously been diagnosed but were not receiving care or treatment, and a further 40 patients (6%) could not be contacted after the positive test to check that they were aware of their diagnoses. This highlights the need for strategies to ensure that patients with hepatitis B are followed up adequately, which requires information, education and patient involvement. It also identifies the need for research into barriers to accessing care which may include stigma, discrimination and language barriers.

Pamela Healy OBE, Chief Executive at the British Liver Trust said:
“If left undetected, the hepatitis B virus can cause liver damage and increase an individual’s risk of developing liver cancer, yet thousands of people in the UK are asymptomatic and unaware they are infected with it.

This latest research reinforces what we already knew – that opt-out testing is highly effective at identifying people living with previously undiagnosed blood borne viruses, such as hepatitis B and hepatitis C, so that they can receive treatment, prevent further complications and ultimately reduce NHS spending in the long term.”

In England alone, over 200,000 people are estimated to be living with chronic hepatitis B (HBV) – the majority are undiagnosed, unlinked to care and at higher risk of premature death from cirrhosis and liver cancer.

Professor Raj Mookerjee, Secretary of the British Association for the Study of the Liver said:
“The opt-out testing programme in Emergency Departments in England has identified an unprecedented number of new cases of hepatitis B, particularly from disadvantaged groups who are less likely to come forward for routine testing, and whose only interaction with healthcare services has been via emergency departments.

Although the surge in demand for services and access to treatment has added to NHS pressures, wwe must continue to work with policy makers to identify affected patients and address the health inequalities to ensure that everyone has access to the treatment and care that they need.”

Senior author of the research, Dr Kate Childs, King’s College Hospital NHS Foundation Trust said:
“This program has successfully identified a large number of patients with hepatitis B infection, who were either undiagnosed or not in care. Many of those tested live in areas of deprivation and have difficulty in accessing healthcare. This program empowers this group of individuals to attend for hepatitis B care, prevent onwards transmission and reduce the long-term risk of complications including liver cancer. Adequate resources are needed to ensure that hepatitis services are able to review and treat these patients in a timely manner.”

In November 2023, NHS England expanded the scope of opt-out testing for HIV and viral hepatitis in emergency departments to 47 sites across England. The British Liver Trust is calling for opt-out testing to be made routinely available across the UK.

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- QuestPrehab to begin working with 50 patients requiring liver transplantation
- First prehab service to work remotely with patients waiting on a transplant list
- The year-long trial to focus on anxiety reduction and improvement of liver frailty scores
- Potential to expand the service to patients with other liver diseases

Wednesday 17th July 2024: Kent-based telehealth company QuestPrehab has signed a contract with the University Hospitals Plymouth NHS Trust to deliver digital prehabilitation (‘prehab’) services to liver patients across Devon, Cornwall and Somerset.

The year-long trial with the South West Liver Unit at University Hospitals Plymouth NHS Trust will see QuestPrehab work with 50 patients undergoing assessment and listing for liver transplant. If successful, the service may be expanded to patients living with other liver diseases and who currently are not on the list.

The digital programmes and resources run by the team at QuestPrehab will be specially developed to cater for the clinical and holistic needs of liver patients in collaboration with the Plymouth-based hospital team.

Prehab is a relatively new area of healthcare that focuses on improving the general health and activity of patients before surgery / treatment as a way of aiding their recovery.

Patients who complete their prehab course prior to planned surgery are less likely to be readmitted to hospital, enjoy improved health-related quality of life, return to work earlier and need less involvement with social and primary care providers.

The aim of the trial is to demonstrate two pivotal elements:
- the feasibility of remote delivery of prehab and the benefits in health-related quality of life for patients awaiting liver transplant
- how the usually long waiting time can be utilised in a positive and clinically effective manner … 50% of patients listed for transplant typically have a wait of six months or more

“We’re very excited to have the opportunity to expand much-needed support to our patients here in the south west,” said Professor Matthew Cramp, Consultant Hepatologist at the South West Liver Unit, UHP.

“Liver transplant patients face many challenges and to be able to provide a personalised prehab service while they wait for their surgery is something we’ve been keen to offer for some time. Having the consistency of supervision by a prehab specialist we hope will lead to a lower risk of complications post-transplant and improve quality of life both pre and post-operatively.”

“The signing of this ground-breaking contract with the University Hospitals Plymouth NHS Trust will see us working hand-in-hand with the South West Liver Unit at Derriford Hospital to improve quality of life for their transplant patients,” said QuestPrehab founder Professor Tara Rampal. “Waiting for a liver transplant is an extremely anxious time for all patients. They face the uncertainty of when they will be called up for the transplant whilst also dealing with the consequences of advanced liver disease and the worry that their condition may deteriorate during this time.”

“Patients will receive a highly personalised programme based on four key areas – physical activity, anxiety management, diet advice and lifestyle modifications – with a goal of alleviating their level of anxiety and improving their liver frailty score.”

Each patient will be able to access their individualised programmes via QuestPrehab’s app. Exercise classes and support sessions will be delivered by a combination of phone, Zoom or Skype calls. Those patients who do not have access to suitable technology will be able to loan equipment from the South West Liver Unit during the trial at no cost to themselves.

The 12-month trial will be evaluated through standardised patient reported outcome measures and physical assessment scores.

News of the contract – the first of its kind in the UK – follows QuestPrehab’s recent deal to supply prehab services to two hospitals in China, along with its success in working with NHS oncology patients over the past four years.

Professor Tara Rampal explains: “Our service is scalable and cost efficient, making wide-scale adoption of digital prehab possible. It doesn’t require any modifications to pre-existing infrastructure, processes, patient pathways, or systems, so can be easily inserted into any healthcare provider.”

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