Title : Implementation of a robust screening program for hepatitis C, hepatitis B, and human immunodeficiency virus in an EmPATH emergency psychiatric setting: An opportunity for collaboration and integration
Abstract:
Objectives: Behavioral health populations remain at high risk for hepatitis C (HCV), hepatitis B (HBV), and human immunodeficiency virus (HIV) infection, but screening rates in those settings remain quite low. Further, while effective treatments exist, significant barriers still exist in screening and continuity of care for these disease states. The University of Kentucky (UK) HealthCare Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) unit is an alternative to a traditional emergency department (ED), providing a calming environment for patients presenting with psychiatric distress. Prior literature has observed increased prevalence of HCV, HIV, and HBV in individuals with serious mental illness, with estimates of a 3- to 11-fold increase in HCV risk relative to reference populations. Subsequently, psychiatric emergency and inpatient settings are likely to serve a patient population at high risk for these disease states, making routine screening crucial. This study is one of the first to screen and evaluate the prevalence of HCV, HIV, and HBV in a psychiatric emergency patient population.
Methods: This retrospective, observational study examined the prevalence of HBV, HCV, and HIV in patients who presented to the UK EmPATH unit. A non-targeted screening protocol for HBV, HCV, and HIV was implemented to screen all patients presenting to EmPATH who had no documented negative result for these diagnoses in the prior six months. Screenings were not performed in patients who declined consent or at provider discretion. All patients who presented to UK EmPATH post-implementation (1/20/2025 – 3/16/2026) were included in the study analysis. Demographic data and laboratory results were collected from the medical record. The number and percentage of patients screened and testing positive for HBV, HCV, and HIV are reported in aggregate, with positive patients further classified as either previously diagnosed or newly identified at the encounter.
Results: 6,106 patients were seen in EmPATH and 2,022 (33.1%) were screened for HCV. A large portion had been seen in either a UK ED or at EmPATH in the prior 6 months and were thus not rescreened. Of those eligible for screening, 73.89% were completed, a significant completion rate in a behavioral health setting. Of those screened, 16.15% were HCV Ab positive, of which 48% were HCV RNA positive, and 61.71% of those were new RNA positive findings. Further, 2,832 (46.4%) were screened for HIV, with 1.4% testing positive for HIV and 76.92% being new diagnoses. 2,022 (33.1%) were screened for HBV and 0.69% tested positive for HBV, with 50% being newly diagnosed.
Conclusion: Observed HBV, HCV, and HIV positivity rates were high in a psychiatric ED, justifying non-targeted or universal screening programs in this setting. Further, most diagnoses were known prior to admission, suggesting difficulty with linking this patient population to treatment. Treatment programs focusing on effective coordination of post-discharge care are needed, and best practices in communicating and ensuring screening compliance in this unique population are discussed.
