Abstract
PURPOSE: To evaluate a Blood Born Virus (BBV) infection screening program in an emergency department (ED) located in an urban setting with an intermediate prevalence of undiagnosed BBV infections. METHODS: The program in the ED of the St. Joseph Hospital, Berlin, Germany, was active from June 2021 through April 2024. Patients aged 18-68 undergoing routine blood sampling were eligible for opt-in screening. We analyzed testing uptake, temporal trends, positivity rates, and linkage to care. RESULTS: A total of 23,118 cases were eligible for testing. Screening was offered to 2670 cases (11.5%). 2440 (91.4%) consented of whom 2406 were tested. Testing volumes remained below 11% of the eligible population. Among 2406 cases, 78 (3.2%) individuals were found to have at least one BBV infection. HIV infection was detected in 36 (1.5%) individuals. 12 individuals (0.5%) had previously undiagnosed HIV infection (median [range] CD4 count: 213/µL [66-794]). Linkage to care was successful in 50.0%. HBV was found in 16 (0.7%) individuals, with 6 (0.2%) previously undiagnosed individuals; linkage to care was achieved in 33.3%. HCV was confirmed in 38 (1.6%) individuals, including 13 (0.5%) previously undiagnosed individuals; linkage to care was achieved in 15.4%. Homelessness, substance use, and lack of health insurance coverage were key barriers to successful linkage. CONCLUSIONS: Universal BBV testing in an urban ED proved effective in identifying previously undiagnosed infections. However, due to its opt-in design, the program operated below its potential capacity. Linkage to care was often unsuccessful, largely due to structural barriers.