Undiagnosed HIV, Hepatitis B and Hepatitis C in primary care: Targeted testing using digital technology to increase identification and improve care pathways for higher risk and underserved communities

HIV, Hepatitis B and Hepatitis C are blood-borne viruses, usually transmitted by blood or sexual contact. Left untreated they cause significant illness and death.

Many people in the UK are unaware they are living with these viruses. Blood-borne viruses often affect the most disadvantaged people in the population, causing further disadvantage and harm, widening the inequalities across society.

General population screening can identify undiagnosed people and ensure they get effective treatment. However, these programmes have been inefficient, costly and poorly targeted, for example, offering testing to everyone in the population, irrespective of their risk of infection, and usually only for a single virus.

New and more efficient approaches to identifying people living with blood-borne viruses are urgently needed.

In this project, we will work with people with lived experience of blood-borne viruses to ensure we meet the needs and expectations of those affected. Together, we will co-create a programme that:

effectively and safely identifies people at highest risk of testing positive (“targeted testing”),

is acceptable to those being tested,

supports newly diagnosed people in receiving treatment. Our proposal builds on our development work currently funded by the School for Primary Care Research: we have 1) identified, reviewed and summarised all research published about the use of healthcare computer systems to identify people at highest risk of infection, and 2) developed a computerised scoring system (e.g., 1=very low risk, 10=very high risk) that estimates a person’s risk of having a blood-borne virus infection, based on information already contained in their GP electronic health record.

We now propose to work with people living with blood-borne viruses to develop and evaluate a targeted testing programme

We will:

Refine and test the scoring system we have developed, first using information from patients in East London, and then with information from patients across the UK, to ensure it works well, wherever it is used,

Hold workshops with people with lived experience of blood-borne viruses, to design together the best way to offer testing to people who have scored highly on our scoring system, ensuring it is acceptable (those invited for testing are happy to consent) and effective (the system identifies the right people),

Test the programme in six general practices (two each in London, Bristol and Leicester), gathering the views of patients and staff, and changing the way we do things if needed, to create the best-performing programme in terms of acceptability to patients and value for money.

We will judge success against key criteria; if we meet these, we will progress to seek funding for a UK-wide evaluation of our programme.

We will liaise with study participants, the wider community, local/national government and NHS leaders to share findings and lessons learned.

Amount awarded: £899,204