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Updated: Jun 9, 2025
Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
The Camden and Islington Viral Hepatitis Identification Tool (CIVHIT): Use of a Clinical Database Case-Finding Tool
David Etoori1, Sara Cococcia2,3, Ankur Srivastava2
1National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-Borne and Sexually Transmitted Infections at UCL in Partnership With the UK Health Security Agency (UKHSA), Royal Free Campus, London, UK.
Insights
The Camden and Islington Viral Hepatitis Identification Tool (CIVHIT) significantly increased blood-borne virus (BBV) testing and diagnoses in primary care. This tool shows promise for eliminating viral hepatitis infections.
Area of Science:
- Public Health
- Infectious Diseases
- Health Informatics
Background:
- Hepatitis B (HBV) and C (HCV) infections persist despite available treatments and vaccines.
- Many infected individuals remain undiagnosed, contributing to disease transmission.
- Effective strategies are needed to identify and manage high-risk populations for blood-borne viruses (BBVs).
Purpose of the Study:
- To evaluate the impact of the Camden and Islington Viral Hepatitis Identification Tool (CIVHIT) on BBV testing and diagnosis rates in primary care.
- To assess the effectiveness of a computer-based search tool in identifying individuals at high risk for BBVs.
- To understand patterns of testing and referral for viral hepatitis in a primary care setting.
Main Methods:
- Introduction of the CIVHIT tool in 60 general practices (GPs) to search electronic medical records (EMRs).
- CIVHIT flagged patients based on codes linked to BBV risk factors or medical conditions.
- Analysis of BBV testing rates, new diagnoses, and referral patterns before and after CIVHIT implementation.
Main Results:
- CIVHIT was associated with a 78.5% increase in BBV tests and a 55.8% rise in new diagnoses.
- HBV testing increased significantly, leading to twice as many diagnoses.
- Testing likelihood varied by risk factor (drug use, hepatitis contact, STI history), age, and sex, with lower rates in males for HIV and HBV.
Conclusions:
- The CIVHIT tool demonstrates significant potential to enhance the identification, testing, and diagnosis of BBVs in primary care.
- Targeted flagging based on risk factors can improve testing uptake, although referral rates to secondary care remain low.
- Further optimization of such tools may be crucial for achieving BBV elimination goals.
Abstract:
Despite the availability of effective treatment and vaccines for hepatitis B virus (HBV) and C virus (HCV), many people are still infected and remain unaware of their infection. The Camden and Islington Viral Hepatitis Identification Tool (CIVHIT), a computer-based search tool, was introduced in 60 general practices (GPs) in April 2014 to support identification, testing and treatment of individuals at high risk for blood-borne viruses (BBVs). CIVHIT searched electronic medical records (EMRs), flagging all those with codes linked to risk factors or medical conditions associated with BBVs. CIVHIT was associated with a 78.5% increase in BBV tests in primary care in both boroughs. This translated to a 55.8% rise in new diagnoses. HBV testing saw the largest increase resulting in twice as many people diagnosed. Only 23.2% of HBV and 14.9% of HCV-positive tests were referred to secondary care. In an index practice, the most common flag was a history of STIs (477/719, 66.3%). Individuals with previous or current drug use and those with a known hepatitis contact were more likely to be offered a test compared to those flagged due to a history of STI. HIV and HBV testing was lower in males following a test offer. There was an increased likelihood of testing for HBV and HCV with increasing age. Additionally, individuals with previous or current drug use and individuals with a known hepatitis contact were more likely to test for HCV compared to individuals flagged due to STI history. CIVHIT shows promise to assist with the elimination of BBVs.
