NICE Pathways

Browse Pathways
- Healthcare
  - Acutely ill patients in hospital
  - Allergies
    - Anaphylaxis
    - Food allergy in children and young people
  - Blood diseases
    - Anaemia
      - Anaemia management in people with chronic kidney disease
    - Neutropenia
      - Neutropenic sepsis
        
        Neutropenic sepsis
    - Sickle cell disease
      - Sickle cell acute painful episode
  - Cancer
    - Breast cancer
    - Cancer complications
      - Metastatic spinal cord compression
      - Neutropenic sepsis
    - Colorectal cancer
      - Colonoscopic surveillance
    - Colorectal cancer
    - Lung cancer
    - Ovarian cancer
    - Preventing skin cancer
    - Prostate cancer
  - Cardiovascular diseases
    - Acute coronary syndromes
      - Hyperglycaemia in acute coronary syndromes
    - Heart failure
      - Chronic heart failure
    - Hypertension
    - Lower limb peripheral arterial disease
    - Stroke
    - Venous thromboembolism
  - Child health
    - Alcohol-use disorders
    - Anaemia management in people with chronic kidney disease
    - Atopic eczema in children
    - Bedwetting (nocturnal enuresis) in children and young people
    - Constipation in children and young people
    - Maternal and child nutrition
    - Spasticity in children and young people
    - Surgical management of otitis media with effusion in children
    - Urinary tract infection in children
    - When to suspect child maltreatment
  - Ear diseases
    - Surgical management of otitis media with effusion in children
  - Endocrine diseases
    - Diabetes
      - Diabetes in pregnancy
      - Preventing type 2 diabetes
    - Diabetes
  - Eye diseases
    - Glaucoma
  - Gastrointestinal diseases
    - Acute upper gastrointestinal bleeding
    - Barrett’s oesophagus
    - Coeliac disease
    - Crohn’s disease
    - Irritable bowel syndrome in adults
  - Improving patient and service user experience in adult NHS services
    - Patient experience in adult NHS services
    - Service user experience in adult mental health services
  - Inadvertent perioperative hypothermia
  - Infections and infectious diseases
    - Antibiotics for early-onset neonatal infection
    - Bacterial meningitis and meningococcal septicaemia
    - Hepatitis
      - Hepatitis B and C testing
    - Immunisation for children and young people
    - Prevention and control of healthcare-associated infections
    - Self-limiting respiratory tract infections - antibiotic prescribing
    - Sepsis
      - Neutropenic sepsis
    - Sexually transmitted diseases
      - HIV testing and prevention
      - Preventing sexually transmitted infections and under-18 conceptions
    - Tuberculosis
    - Urinary tract infection in children
  - Kidney diseases
    - Chronic kidney disease
      - Anaemia management in people with chronic kidney disease
    - Chronic kidney disease
  - Liver diseases
    - Hepatitis
      - Hepatitis B and C testing
  - Maternal health
    - Maternal and child nutrition
  - Medicines adherence
    - Medicines adherence
  - Mental disorders
    - Alcohol-use disorders
    - Antenatal and postnatal mental health
    - Autism
    - Delirium
    - Dementia
    - Depression
    - Drug misuse
    - Generalised anxiety disorder
    - Obsessive-compulsive disorder
    - Panic disorder
    - Post-traumatic stress disorder
    - Psychosis with coexisting substance misuse
    - Reducing substance misuse among vulnerable children and young people
    - Self-harm
    - Social and emotional wellbeing for children and young people
  - Metabolic diseases
    - Diabetes
      - Diabetes in pregnancy
      - Preventing type 2 diabetes
    - Diabetes
  - Musculoskeletal diseases
    - Osteoporosis
    - Spasticity
      - Spasticity in children and young people
  - Nervous system diseases
    - Dementia
    - Epilepsy
    - Headaches
      - Headaches
    - Loss of consciousness
      - Transient loss of consciousness
    - Meningitis
      - Bacterial meningitis and meningococcal septicaemia
    - Spasticity
      - Spasticity in children and young people
    - Urinary incontinence in neurological disease
  - Nutrition
    - Nutrition support in adults
  - Palliative care
    - Opioids in palliative care
  - Pregnancy and childbirth
    - Birth
    - Newborn diseases
      - Antibiotics for early-onset neonatal infection
      - Neonatal jaundice
    - Postnatal care
      - Maternal and child nutrition
    - Postnatal care
    - Pregnancy
    - Pregnancy complications
      - Diabetes in pregnancy
      - Ectopic pregnancy and miscarriage
        
        Ectopic pregnancy and miscarriage
  - Rehabilitation after critical illness
  - Respiratory diseases
    - Chronic obstructive pulmonary disease
    - Self-limiting respiratory tract infections - antibiotic prescribing
    - Tuberculosis
  - Signs and symptoms
    - Constipation
      - Constipation in children and young people
    - Hypothermia
      - Inadvertent perioperative hypothermia
    - Low back pain (early management)
    - Pain
      - Headaches
  - Skin conditions and diseases
    - Atopic eczema in children
    - Pressure ulcer management
    - Preventing skin cancer
    - Psoriasis
  - Tissue and organ donation
    - Organ donation for transplantation
  - Urological diseases
    - Bedwetting (nocturnal enuresis) in children and young people
    - Lower urinary tract symptoms in men
    - Urinary incontinence in neurological disease
  - Wounds and injuries
    - Bone fractures
      - Hip fracture
      - Osteoporosis
    - Pressure ulcer management
- Public health

Hepatitis B and C testing

Short Text

Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection.

Introduction

This pathway aims to ensure more people at increased risk of hepatitis B and C infection are tested. It covers:

Awareness-raising among:
- the general population
- people at increased risk of hepatitis B and C infection.
Developing the knowledge and skills of healthcare professionals and others providing services for people at increased risk of hepatitis B or C infection.
Testing:
- in primary care
- in prisons and youth offender institutions
- in immigration removal centres
- in drugs services
- in genitourinary medicine and sexual health clinics.
Contact tracing.
Providing and auditing neonatal hepatitis B vaccination.
Commissioning hepatitis B and C testing and treatment services.
Laboratory services for hepatitis B and C testing.

This pathway does not provide detail on treatments for hepatitis B or C.

Pre-requisites

The recommendations in this pathway are based on the assumption that hepatitis B and C tests are provided according to current best practice and are offered as part of a care pathway covering diagnosis, treatment and immunisation.

Testing

The recommendations assume that:

Testing facilities are equipped with sharps bins and follow advice on infection control and appropriate testing methods, particularly if testing is done outside healthcare settings.
People being tested for hepatitis B and C are offered pre- and post-test discussions (see 'Areas to consider when offering a test for hepatitis B or C' below).
Testing is undertaken with the person's consent.
Standards for local surveillance are followed, including laboratory reporting to Public Health England centres and follow-up of hepatitis B and C.

Areas to consider when offering a test for hepatitis B or C

Have issues of confidentiality and anxiety been addressed?
Has the offer been accompanied by an agreed mechanism for providing the result to the person being tested?
Has the offer been phrased in a way that suits the person's age, culture and literacy level and is respectful and non-judgemental?
Has the offer taken into account potential barriers to testing such as the stigma associated with hepatitis B and C or lack of access to services?
Has the offer included information to enable people to make informed choices about their care should they test positive, and to reduce their risk of hepatitis B and C infection should they test negative?
Has the offer been accompanied by details of support available for clinical and non-clinical needs, both while waiting for test results and following diagnosis?

Treatment

NICE has recommended a number of drugs to treat hepatitis B and C and also has clinical guidelines in development on the diagnosis and management of hepatitis B and C. Guidance on managing co-infection with HIV-1 and hepatitis B or C is available from the British HIV Association NICE has accredited the process used by the British HIV Association to produce UK national guidelines. Accreditation is valid for 5 years from 12 July 2012 and is applicable to guidance produced since 2011. The NICE Accreditation Scheme recognises organisations that demonstrate high standards in producing health or social care guidance. Users of the accredited guidance can therefore have high confidence in the quality of the information.. The European Association for the Study of the Liver (EASL)Guidance produced by EASL has not been reviewed by the NICE Accreditation Scheme. EASL guidelines may assist healthcare providers in the clinical decision-making process by describing a range of generally accepted approaches for diagnosing, treating and preventing hepatitis B and C. However, it should be ensured that action taken is in line with NICE guidance. has published best practice guidelines on managing hepatitis B and hepatitis C.

Immunisation

Guidance on hepatitis B vaccination is available in the Green book: immunisation against infectious diseases and the Hepatitis B antenatal screening and newborn immunisation programme, both published by the Department of Health, and in the NICE pathway on Reducing differences in the uptake of immunisations.

Source guidance

The NICE guidance that was used to create the pathway.

Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection. NICE public health guidance 43 (2012)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Costing support

Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.

Hepatitis B and C testing: costing report

Hepatitis B and C testing: costing template

Education tools

NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.

Hepatitis B and C testing: support for education and learning: practice-based implementation advice

Pathway information

Updates to this pathway

14 December 2012 Minor maintenance updates

Supporting information

Whose health will benefit?

In the UK, the majority (95%) of new chronic hepatitis B infections occur in migrant populations, having been acquired perinatally in the country of birth. In contrast, approximately 90% of chronic hepatitis C infections are seen in people who inject drugs or have done so in the past.

Groups at increased risk of hepatitis B compared with the general UK population include:

People born or brought up in a country with an intermediate or high prevalence (2% or greater) of chronic hepatitis B. This includes all countries in Africa, Asia, the Caribbean, Central and South America, Eastern and Southern Europe, the Middle East and the Pacific islands.
Babies born to mothers infected with hepatitis B.
People who have ever injected drugs.
Men who have sex with men.
Anyone who has had unprotected sex, particularly:
- people who have had multiple sexual partners
- people reporting unprotected sexual contact in areas of intermediate and high prevalence
- people presenting at sexual health and genitourinary medicine clinics
- people diagnosed with a sexually transmitted disease
- commercial sex workers.
Looked-after children and young people, including those living in care homes.
Prisoners, including young offenders.
Immigration detainees.
Close contacts of someone known to be chronically infected with hepatitis B.

For hepatitis C, groups at increased risk include:

People who have ever injected drugs.
People who received a blood transfusion before 1991 or blood products before 1986, when screening of blood donors for hepatitis C infection, or heat treatment for inactivation of viruses were introduced.
People born or brought up in a country with an intermediate or high prevalence (2% or greater) of chronic hepatitis C. For practical purposes this includes all countries in Africa, Asia, the Caribbean, Central and South America, Eastern and Southern Europe, the Middle East and the Pacific islands.
Babies born to mothers infected with hepatitis C.
Prisoners, including young offenders.
Looked-after children and young people, including those living in care homes.
People living in hostels for the homeless or sleeping on the streets.
HIV-positive men who have sex with men.
Close contacts of someone known to be chronically infected with hepatitis C.

Glossary

The people in close contact with someone infected with hepatitis B or C, where there is a risk of transmitting the infection (through blood or body fluids). This could include their family members, close friends, household contacts or sexual partners.

Continuation of treatment and referral for people moving in, out or between prisons.

In addition to housing people who remain in the UK illegally, immigration removal centres house people who are waiting for their immigration claims to be resolved or to have their identities established. Detainees are entitled to primary healthcare facilities during their stay, equivalent to those available in the community.

A model of prison-based healthcare provision in which healthcare services are brought into the prison, instead of the prisoner being taken out to the healthcare service (for example, to a hospital outpatient unit).

A process that identifies the current and future health and wellbeing needs of a local population, leading to agreed commissioning priorities that aim to improve outcomes and reduce health inequalities.

Additional services provided by GPs, designed to meet specific local health needs.

A process to ensure prisoners are not transferred until they are medically fit.

Hepatitis B and C can be cleared by the body's own immune system. An antibody test determines whether a person has ever been infected with hepatitis in the past. If the test is positive further tests are carried out to establish whether the virus is still present in the body.

Peers are members of the target population who have been diagnosed with hepatitis B or C. They may be recruited and supported to communicate health messages, including promoting testing and treatment, assist with contact tracing or testing, and to offer people support during testing and treatment.

Polymerase chain reaction.

Her Majesty's prison establishments, including young offender institutions.

Intimate contact with others, including kissing and oral, anal, and vaginal intercourse. Hepatitis B is transmitted by direct contact with infected blood. However, it can also be transmitted by contact with semen, vaginal fluids and other body fluids. Hepatitis C is primarily transmitted by contact with infected blood.