Sep. 02, 2024
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Screening for Viral Hepatitis
I didn’t know anything about [hepatitis C] so didn’t know what to think except feeling like my life was over. I was only 27 years old, and thought I would not reach 30.
Kathleen (Hepatitis C Support Project, )
In substance abuse treatment environments, healthcare professionals often take the lead in screening patients for hepatitis, clarifying the screening procedure and interpreting test results. Opioid treatment facilities that employ medical personnel should perform hepatitis B and C tests during initial evaluations and at regular intervals as necessary. For programs lacking on-site medical staff, clients may be directed to external testing facilities, with little involvement from the treatment program staff.
Irrespective of program type, counselors ought to possess fundamental awareness of the significance of screening, the methodology involved, and what the results signify. They should encourage clients referred for screening to finalize the evaluation process, as mentioned in Chapter 3. Clients may experience apprehension regarding hepatitis diagnosis, potentially leading to delays or avoidance of testing altogether.
Hepatitis screening requires a blood sample that checks for specific antigens and antibodies indicative of viral hepatitis infection. Antigens are foreign elements such as pathogens or chemicals that invade the body, prompting an immune response that produces antibodies—proteins designed to neutralize these antigens. Hepatitis blood tests identify specific antigens or antibodies corresponding to each hepatitis virus type.
To screen for hepatitis A, blood tests for antibodies to the hepatitis A virus (HAV) are conducted. These tests are often called hepatitis A antibody tests or hepatitis A total antibody tests.
A positive result confirms that the individual either has experienced HAV infection previously or has been vaccinated, granting immunity. Conversely, a negative result indicates that no antibodies are present, suggesting that the individual has neither been vaccinated nor infected and remains susceptible to HAV.
Hepatitis B virus (HBV) comprises several antigens found throughout the virus. There are three primary antigens (surface, core, and e), and the body's immune system generates specific antibodies for each. Hepatitis B screening encompasses three essential tests: a hepatitis B surface antigen test (determining current infection), a hepatitis B core antibody test (indicating past infection), and a hepatitis B surface antibody test (showing immunity from vaccination or successful infection clearance).
Is the person currently infected with HBV? The hepatitis B surface antigen test identifies the presence of HBV in the bloodstream, generally becoming detectable 4-10 weeks following exposure. A positive result indicates active infection and potential for transmission. While most adults expel HBV within a few months, some develop chronic HBV infection if the antigen remains positive after 6 months. Chronic hepatitis B requires further evaluation (see Chapter 3).
Has the person ever been infected with HBV? The core antibody test reveals antibodies to the HBV core antigen, appearing in blood shortly after infection. A positive indicates past HBV infection but does not clarify whether the virus was cleared or remains.
Is the person immune to HBV? The surface antibody test detects antibodies that signify successful vaccination or cleared infection. A positive result indicated immunity for life (CDC). In situations where HBV screening is unavailable, vaccination is still an option for previously infected or vaccinated individuals.
HCV screening focuses on antibodies to hepatitis C in blood. Interpretation of results requires caution: a positive HCV antibody test may signify chronic infection (75%-85%), resolved infection (15%-25%), or recent onset infection (CDC). Generally, antibody development occurs within 6-8 weeks post-infection; longer periods can apply for individuals with suppressed immunity. Early infections might elude detection, but an infection present beyond 6 months will usually be detectable.
A positive antibody test implies past infection, but not necessarily current infection. About 25% of HCV patients clear the virus within 6 months, although antibodies persist. The majority of antibody tests necessitate laboratory processing but recent FDA approval facilitates rapid antibody testing for individuals above 15 at potentially higher risk. Although these rapid tests yield results within around 20 minutes, definitive diagnosis mandates further testing (FDA).
Individuals testing positive must pursue additional tests for clarification. Commonly, a qualitative HCV RNA test assesses viral presence. Quantitative tests gauge viral load (see Chapter 3). Given the complexity of HCV antibody testing, some healthcare providers might await follow-up results before disclosing antibody test findings to patients. Chronic infection necessitates the presence of HCV RNA for at least 6 months.
HCV Screening Process.
Clients might need help deciding whether to get screened, understanding the test results, and determining their next steps.
In at-risk individuals, false positives for HCV antibody testing are infrequent, rendering a positive result highly likely to indicate current infection. Conversely, while negative antibody tests are usually accurate, those engaging in high-risk behaviors should retest annually.
Clients may require assistance in deciding regarding screening and comprehending test outcomes. Even within limited service breadth, discussing hepatitis testing creates a chance for counselors to motivate lifestyle changes and encourage health-enhancing decisions. Documented benefits arise from addressing hepatitis screening in conjunction with treatment services. Yet, limited vaccination coverage was demonstrated in one methadone clinic despite high screening participation rates (Felsen et al.).
Recommendations from the Consensus Panel include:
Recognize screening as educational, extending beyond mere blood tests to inform clients about hepatitis implications and preventative measures.
Realize that many clients may lack awareness of previous screening or results, confusing varied test types.
Clarify that hepatitis testing is optional, with patient consent being paramount (Munoz-Plaza et al.).
Commit to follow-ups irrespective of the results to enhance message delivery and prevention engagement (Munoz-Plaza et al.).
Many clients enter substance abuse treatment unaware of their hepatitis status. Research indicates that significant portions of clients, unaware of prior infections, tested positive for HCV (Kwiatkowski et al.; Felsen et al.).
Counselor: Hi, Jim. I’m glad you came in today. We’ve focused a lot on your drug use and you’ve described a lot of consequences in terms of your relationships, job, and finances. Today, I wondered if it would be okay to talk about how your use has generally affected your health. Jim: Sure, I guess so. Counselor: Great! First, I’d like to know how much you know about your risks of getting hepatitis due to your injection drug use. Jim: Well, I know some folks who have gotten sick and died from it, but I also know some who got treated and seem to be okay. I’m worried that I may have this infection and will end up like the ones who died—I’m not very lucky. Counselor: It is true that hepatitis can lead to death in some people, but there have been some important improvements in hepatitis treatment over the past few years. But before we talk about hepatitis treatment, I’d like to talk a bit about how the virus is spread, tests for hepatitis, and some factors, such as alcohol use, that can affect how the virus damages the liver. Is that okay? Jim: It’s something that I’d rather not think about, but I know I should. I’ve avoided getting tested because I’m worried that I’ll test positive. I don’t have any health insurance and can’t afford treatment. Counselor: That’s a lot to worry about, so I do understand why you’re unsure about the next steps, if any, to take. So let’s talk a bit more about what you think your next step should be. I can tell you that we’ll do everything we can to help you. And please remember that not everyone who tests positive for hepatitis needs treatment. So, what do you think?
For many clients, discussions like this might be their first introduction to hepatitis. Counselors can utilize motivational strategies to facilitate client engagement on the topic.
It is crucial that a treatment counselor or health professional use a non-judgmental and compassionate tone.
Utilizing a nonjudgmental and compassionate approach is vital for fostering client comfort in discussing health and risky behaviors. Strategies include:
Display educational materials or related literature to prompt inquiries about hepatitis (see Appendix C for resources).
Evaluate clients’ openness and communication style to tailor discussions effectively.
Introduce hepatitis topics sensitively to prevent feelings of defensiveness; establishing relatable connections can ease conversations.
Be patient and repetitive; gradual discussions may reduce anxiety or shame regarding the virus.
Clients might believe they understand viral hepatitis, but their knowledge may be flawed. Misconceptions surrounding Hepatitis A, B, and C are common. Counselors should succinctly cover these points:
Convey messages clearly and concisely.
Utilize client-understandable language.
Implement visual aids as needed
Express numerical data in relatable terms.
Reiterate information periodically; retention rates wane quickly.
Pay attention to client reactions to foster understanding and rapport.
Use opportunities to underline substance use impacts on liver health.
Screening creates a chance to emphasize behaviors contributing to hepatitis transmission risk:
Assess the client's self-perceived risk of hepatitis infection.
Identify high-risk behaviors, particularly those related to injection drug use and unprotected sex.
Evaluate the client’s alcohol consumption habits.
Once clients feel comfortable discussing viral hepatitis, readiness for screening can increase. Providing reassurance about the simplicity of the testing process greatly diminishes anxiety. As some treatment facilities lack screening options, referrals may be necessary. Use the following strategies to enhance discussions about the screening process and prevention:
Inquire if a client has previously undergone hepatitis testing.
Repeat information as needed based on client-counselor rapport and understanding.
Articulate the benefits of screening such as early diagnosis opportunities.
Clarify the procedure involved, addressing any sensitivity concerns.
Inform clients about the expected time frame for results and alleviate concerns regarding delays.
Collaboratively outline plans for attending screening appointments.
Ensure emotional support is in place during the results-waiting period, recommending support groups as necessary.
Clarify implications of potential results with simple language.
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Plan for sharing screening result discussions, encouraging follow-up.
Medical personnel typically relay screening outcomes—not counselors. Hepatitis screening should accompany intake evaluations in opioid treatment contexts, with results provided by medical staff. Nevertheless, clients might seek counselor engagement to process results.
Anxiety may hinder some clients from adequately understanding or remembering information discussed, necessitating repetition.
For negative results, consider these suggestions:
Deliver results transparently: “So the HCV antibody screening result was negative? This means that, as of 6 months ago, you did not have hepatitis C.”
Emphasize that negative results do not grant immunity, reinforcing prevention tactics.
Highlight the necessity for vaccinations against HAV and HBV, detailing affordable options.
Clients whose tests indicate chronic hepatitis require further assessments conducted by specialists, aimed at obtaining precise diagnostics regarding overall health and liver condition—details outlined in Chapter 3.
Preparatory guidelines for clients addressing chronic hepatitis results include:
Encourage clients to check referrals for further assessment and nurture appointment adherence.
Clarify that screening test results alone necessitate further exploration of health status.
Prepare clients to contemplate follow-up evaluations, stressing that post-test results may influence treatment decisions.
Help identify any testing barriers and strategize overcoming them.
Clients exhibit varied reactions when receiving positive test results, with anxiety complicating their comprehension. Various concerns will surface related to treatment implications for family and personal lives, or fears surrounding confidentiality. Positive results may concern some less than ongoing treatment for substance use disorders.
To alleviate concerns surrounding positive results:
Explain results simply: “Let’s look at your test result, and then we’ll talk about how best to understand it. The HCV test result is positive, indicating past infection.”
Gauge emotional reactions: “How do you feel about knowing that you have been infected with hepatitis C? What does this result mean to you?”
Address immediate worries before providing further information.
Communicate liver health information clearly, catering to the client’s understanding.
Provide reassurance and reminders that many protect their liver health efficiently.
Stress vaccination importance against hepatitis A and B to mitigate complications from ongoing infections.
Urge clients to refrain from alcohol consumption to avoid exacerbating liver issues.
Warn against self-medication prior to consulting healthcare providers; many over-the-counter or herbal items can damage the liver.
Encourage clients to ascertain their HIV status due to its interplay with HBV and HCV complications and advise measures to prevent HIV infection if they are not positive.
Discuss transmission avenues for hepatitis to enable preventative actions:
HCV spreads via exposure to infected blood through shared injection paraphernalia.
It does not transmit through casual contact, sneezing, or coughing.
Sexual transmission risk for HCV is minimal but exists for HBV.
Open wounds should be treated, yet hepatitis infections do not preclude working or attending school.
HCV-infected individuals cannot donate blood or organs.
In instances of relapse, drug paraphernalia sharing should be avoided, and treatment should resume.
Hepatitis A screening entails blood tests measuring antibodies connected to the virus.
A positive test signifies infection, past exposure, or vaccination implying immunity.
A negative result indicates susceptibility due to no infection or vaccination.
Hepatitis B screening necessitates blood tests that evaluate HBV antigens and antibodies.
The surface antigen test checks for active infection.
The core antibody test reveals past infection markers.
The surface antibody test confirms lifelong immunity post-clearance or vaccination.
Hepatitis C screening confirms antibody presence—result interpretation requires careful consideration.
A positive result means a past or current infection, meriting further testing.
A negative may indicate no past infection or recent infection, with follow-up necessary.
Counselors leverage screening as an educational moment to:
Instruct clients on hepatitis specifics.
Ascertain risky behavior patterns.
Advocate for HAV and HBV vaccinations.
Serve as prevention educators for hepatitis transmission.
A hepatitis panel is a series of blood tests assessing whether you currently have a viral hepatitis infection or had one previously. It can also reveal immunity stemming from vaccination against particular hepatitis types.
Hepatitis is a liver disease causing inflammation, predominantly instigated by hepatitis A, hepatitis B, and hepatitis C viruses. A hepatitis panel blood test seeks evidence of infections caused by any of these viruses.
Different hepatitis viruses transmit through various routes, affecting health diversely:
Hepatitis A spreads primarily by consuming food or water tainted with minute stool traces from an infected person—often resulting from inadequate handwashing after bathroom use.
Most individuals recover independently, without lasting liver damage.
Hepatitis B transmits via contact with body fluids from infected individuals, primarily through sexual activities or shared needles.
While many recover without chronic issues, some develop long-term infections, potentially leading to severe liver diseases. Antiviral treatments may aid those cases.
Hepatitis C is mainly spread through exposure to infected blood, with drug-use equipment sharing being a common route.
Most patients progress to chronic infections, but effective treatments now exist. Without intervention, chronic hepatitis C can progress to severe conditions like cirrhosis or liver cancer.
A hepatitis panel contains tests for hepatitis antigens and antibodies:
Both antigens and antibodies may exist in the bloodstream, even when infection symptoms are absent.
Other names include acute hepatitis panel, viral hepatitis panel, and hepatitis screening panel.
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