title: Expanded blood borne virus testing in a tuberculosis clinic. A cost and yield analysis.
abstract: OBJECTIVE
  Testing for HIV is a standard of care for people with active tuberculosis (TB). People investigated for TB in the UK often originate from areas with a high prevalence of HIV and other blood borne viruses (BBV). However, assessment for these infections is patchy. We determined the yield and costs of different testing strategies for BBV in a UK TB clinic.
  
  
  METHODS
  Since 2009, it has been routine to test all TB clinic attendees. Demographic, clinical and virological data were retrospectively extracted from patient notes and hospital databases.
  
  
  RESULTS
  Over 3 years, 1036 people were assessed in the TB service. 410 had a final diagnosis of active TB. HIV testing of the latter population diagnosed 27 new HIV cases at a cost of £3017. When BBV testing was offered to all clinic attendees, a further 6 (total 33) new HIV, 5 Hepatitis B (HBV) and 2 Hepatitis C (HCV) diagnoses were made at a total cost of £22,170.
  
  
  CONCLUSIONS
  We have identified previously undiagnosed HIV, HBV and HCV in a TB clinic population. Our data suggest that despite increasing upfront expense, the associated yield argues strongly for BBV testing to be offered to all patients being investigated for possible TB, irrespective of their final diagnosis.
authors.affiliation: Department of Health and Population Sciences, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom. Electronic address: janey.sewell@nhs.net.
authors.forename: J
authors.initials: J
authors.lastname: Sewell
authors.affiliation: Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom. Electronic address: santino.capocci@nhs.net.
authors.forename: S
authors.initials: S
authors.lastname: Capocci
authors.affiliation: Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom. Electronic address: jwpjohnson@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Johnson
authors.affiliation: North Central London TB Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom. Electronic address: angelita.solamalai@nhs.net.
authors.forename: A
authors.initials: A
authors.lastname: Solamalai
authors.affiliation: Department of Infectious Diseases, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom. Electronic address: susanhopkins@nhs.net.
authors.forename: S
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: Department of Infectious Diseases, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom. Electronic address: iancropley@nhs.net.
authors.forename: I
authors.initials: I
authors.lastname: Cropley
authors.affiliation: Department of Virology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom. Electronic address: danielwebster@nhs.net.
authors.forename: D P
authors.initials: DP
authors.lastname: Webster
authors.affiliation: Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom; University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom. Electronic address: marclipman@nhs.net.
authors.forename: M
authors.initials: M
authors.lastname: Lipman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D064790:Clinical Laboratory Services / Q000191:economics*; D003365:Costs and Cost Analysis; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014376:Tuberculosis; D055815:Young Adult
keywords: HIV infection; Hepatitis B virus; Hepatitis C virus; Tuberculosis; Tuberculosis management