Preparing Clients For Screening
Once clients are comfortable talking about viral , they might be more willing to undergo screening. However, clients might be anxious about the test itself a reassurance that testing is a simple procedure can help allay these concerns. Many substance use treatment facilities do not offer screening, and clients might need to be referred elsewhere. The following strategies can enhance the discussion of the hepatitis screening process and hepatitis prevention:
What Does Hepatitis B Surface Antibody Borderline Non Reactive Mean
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Understanding Your Test Results
Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider so you understand your test results and your hepatitis B status. Are you infected? Protected? Or at risk? The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known in order to confirm your status.
Below is a chart with the most common explanation of the test results, but unusual test results can occur. Please note that this chart is not intended as medical advice, so be sure to talk to your health care provider for a full explanation and obtain a printed copy of your test results. In some cases, a person could be referred to a liver specialist for further evaluation.
More Detailed Information About Hepatitis B Blood Tests
An acute hepatitis B infection follows a relatively long incubation period – from 60 to 150 days with an average of 90 days. It can take up to six months, however, for a person to get rid of the hepatitis B virus. And it can take up to six months for a hepatitis B blood test to show whether as person has recovered from an acute infection or has become chronically infected .
The following graphic from the U.S. Centers for Disease Control and Prevention represents the typical course of an acute hepatitis B infection from first exposure to recovery.
According to the CDC, a hepatitis B blood test result varies depending on whether the infection is a new acute infection or a chronic infection.
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About The Hepatitis B Virus
The hepatitis B virus is a small DNA virus that belongs to the Hepadnaviridae family. Related viruses in this family are also found in woodchucks, ground squirrels, tree squirrels, Peking ducks, and herons.
Structure of the Hepatitis B Virus The hepatitis B virus contains an outer envelope and an inner core.
- The outer envelope of the virus is composed of a surface protein called the hepatitis B surface antigen or HBsAg. The HBsAg can be detected by a simple blood test and a positive test result indicates a person is infected with the hepatitis B virus.
- The inner core of the virus is a protein shell referred to as the hepatitis B core antigen or HBcAg, which contains the hepatitis B virus DNA and enzymes used in viral replication.
Life Cycle of the Hepatitis B Virus
The hepatitis B virus has a complex life cycle. The virus enters the host liver cell and is transported into the nucleus of the liver cell. Once inside the nucleus, the viral DNA is transformed into a covalently closed circular DNA , which serves as a template for viral replication . New HBV virus is packaged and leaves the liver cell, with the stable viral cccDNA remaining in the nucleus where it can integrate into the DNA of the host liver cell, as well as continue to create new hepatitis B virus. Although the life cycle is not completely understood, parts of this replicative process are error prone, which accounts for different genotypes or genetic codes of the hepatitis B virus.
How The Test Is Performed
Blood is most often drawn from a vein from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine . The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the provider gently inserts a needle into the vein. The blood collects into an airtight tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed. The puncture site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.
The blood sample is sent to a lab to be examined. Blood tests are used to check for antibodies to each of the hepatitis viruses.
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Educating Clients About Viral Hepatitis
Clients may believe they know about viral , but their understanding of the disease may not be accurate. It is easy to confuse the three main types of viral , B, and C. Clients may have formed impressions based on limited or incorrect information. Counselors should briefly describe hepatitis A, B, and C, including their prevalence, , and relationship to drug use, as well as to other infections, such as HIV and sexually transmitted diseases. Specific strategies for speaking with clients include:
- Speak clearly and keep the message simple, focused, and brief.
- Use language, examples, and concepts that the client understands.
- Use appropriate visual aids.
- Frame numerical statements in terms that are easy to visualize. Say 5 out of 100 people rather than 5 percent of the population say more than half instead of the majority.
- Repeat the information at different times in different ways. The average client retains only approximately one-third of what he or she is told. Summarize essential points.
- Pay attention to a clients response to the information. For example, if a client stiffens his or her posture, consider saying, I notice that this topic seems to make you uncomfortable. It does for a lot of people. Please tell me what youre feeling right now. Id really like to help you with this.
- Use the opportunity to describe the potential detrimental effects of alcohol and other substance use on the liver of a person who is infected with HCV.
Taking A Hepatitis B Test
Testing for hepatitis B is performed on a sample of blood. A doctor, nurse, or other health care provider can obtain a blood sample using a small needle to draw blood from a vein.
At-home hepatitis B testing requires that users carefully follow instructions provided in the test kit to collect a small sample of blood, package the sample, and mail it to a lab for testing.
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How To Get Tested
Hepatitis B testing is typically prescribed by a doctor and performed in a hospital, lab, or other medical setting. Taking a hepatitis B test requires a blood sample, which can be collected by a health care professional.
For laboratory-based testing, blood is drawn from a patientÃ¢s vein. After blood is collected, the sample is sent to a laboratory for analysis.
Hepatitis B Vaccine And Surface Antibody Titer Faqs
PLEASE NOTE: This is program specific some programs require 3 Hepatitis B vaccines AND a positive Hepatitis B Surface Antibody titer while others will accept 3 vaccines OR a titer. Please read the information in your CastleBranch account carefully so that you know exactly what you need to meet your programs requirements. If you have any questions, please email and a team member will respond.
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Cautions Discusses Conditions That May Cause Diagnostic Confusion Including Improper Specimen Collection And Handling Inappropriate Test Selection And Interfering Substances
Positive screen results without need for confirmation testing should be interpreted in conjunction with test results of other hepatitis B virus serologic markers .
Positive hepatitis B surface antigen test results should be reported by the health care provider to the State Department of Health, as required by law in some states.
Individuals, especially neonates and children, who recently received hepatitis B vaccination may have transient positive HBsAg test results because of the large dose of HBsAg used in the vaccine relative to the individualâs body mass.
Performance characteristics have not been established for the following specimen characteristics:
-Containing particulate matter
Treatment Options For Hepatitis B
Acute hepatitis B usually doesnt require treatment. Most people will overcome an acute infection on their own. However, rest and hydration will help you recover.
Antiviral medications are used to treat chronic hepatitis B. These help you fight the virus. They may also reduce the risk of future liver complications.
You may need a liver transplant if hepatitis B has severely damaged your liver. A liver transplant means a surgeon will remove your liver and replace it with a donor liver. Most donor livers come from deceased donors.
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Antibody To Hepatitis B Surface Antigen
Harvest Order Choice: 90640
Synonyms: Anti-HBs HBs Ab Hepatitis B Post-vaccine screen
Unit: Viral Serology
Useful For: Qualitative and quantitative enzyme immunoassay for the detection of antibody to hepatitis B surface antigen in human serum and EDTA, heparin, or citrated plasma. The assay results may be used as an aid in the determination of susceptibility to hepatitis B virus infection in individuals prior to or following HBV vaccination or where vaccination status is unknown. Assay results may be used with other HBV serological markers for the laboratory diagnosis of HBV disease associated with HBV infection.
Method: Enzyme Immunoassay
Request Form: SRD-1
Container/ Tube: The following tube types and anticoagulants, including those in both glass and plastic tubes, have all been evaluated and found to be acceptable: SST, EDTA, sodium citrate, lithium heparin, and sodium heparin.
Type: Human serum or plasma
Volume: Fill tubes as labeling indicates to avoid improper dilution
Collection Instructions: venipuncture
Storage: Serum/ plasma should remain at room temperature for no longer than eight hours. If assays are not completed within eight hours, serum/plasma should be refrigerated at 2-8C. Specimens may be stored at 2-8C for 7 days. For long-term storage, the specimens should be frozen . Specimen should not be used if they have incurred more than 5 freeze-thaw cycles. Mix specimens thoroughly after thawing.
Reference Interval: Negative, non-reactive
Sequence Following An Initial Negative Hepatitis B Surface Antibody Titer
As you obtain documentation, please submit documentation of each step to CastleBranch
- Initial Hepatitis B titer negative for immunity
- Receive Hepatitis B challenge dose/booster
- Repeat Hepatitis B titer 4-6 weeks after challenge/booster vaccine
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Discussing Screening Results With Clients
The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.
Anxiety might interfere with some clients ability to comprehend or retain information, which might need to be repeated.
Suggestions for conversations with clients when the test results are negative include the following:
- Explain results clearly and simply: So the HCV screening result was negative? This means that, as of 6 months ago, you did not have .
- Emphasize that a negative result to an HCV test does not indicate to and that the client should take precautions to avoid . If a relapse to drug use occurs, advise clients to avoid sharing any drug paraphernalia or equipment. Specify that this includes cookers, cotton, water, needles, syringes, pipes, and straws.
- Emphasize the importance of getting HAV and HBV vaccinations. Provide information about the availability of low- or no-cost vaccinations.
Clients whose screening test results are positive for will need additional tests and examinationsusually with doctors who specialize in diseases of the liver to get accurate diagnoses and to determine their health status and the extent of liver damage. These tests are described in .
Why The Test Is Performed
Your provider may order this test if you have signs of hepatitis. It is used to:
- Detect current or previous hepatitis infection
- Determine how contagious a person with hepatitis is
- Monitor a person who is being treated for hepatitis
The test may be performed for other conditions, such as:
- Chronic persistent hepatitis
A normal result means no hepatitis antibodies are found in the blood sample. This is called a negative result.
Normal value ranges may vary slightly depending on the lab doing the test. Talk to your provider about the meaning of your specific test results.
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Counseling Practices That Educate Support And Motivate Clients Undergoing Screening
Clients might need help deciding whether to get screened, understanding the test results, and determining their next steps. Even when services offered through the substance abuse treatment program are limited, discussing testing with clients presents an opportunity for counselors to motivate clients for change by confronting substance use and by making choices that improve their overall health. However, this may also be true when services are offered on-site through substance abuse treatment programs. A study at one methadone clinic that offered hepatitis screening and vaccination revealed that although the majority of clients completed screening , only 54.7 percent of clients who lacked for hepatitis A received vaccinations and only 2.9 percent of clients who lacked immunity for received vaccinations .
The Consensus Panel makes the following general recommendations while recognizing that, in some programs, the counselors role may be limited:
Preparation Prior To Transport
Label the specimen container with the patients full name, date of collection and one other unique identifier such as the patients date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.
Centrifuge if using SST. Place specimen in biohazard bag and seal. Specimens should be stored at 2-8Â°C following collection.
Specimens more than the following number of days post collection will not be tested:
- > 6 days for Hepatitis B surface antigen
- > 7 days for Hepatitis B e Antigen and Hepatitis B e Antibody
- > 10 days for Hepatitis B core Antigen and Hepatitis B surface Antibody
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Question 5 What Is The Natural History Of Hepatitis B Surface Antibody During Acute Hepatitis B Infection And Convalescence
HBsAg can be detected in the blood 4 to 10 weeks after exposure. This corresponds to onset of symptoms and viremia detectable by nucleic acid amplification methods. Most hepatitis B infections are self-limited and are associated with disappearance of HBsAg within 4 weeks of onset of symptoms. The anti-HBs then appears and increases to a plateau level that persists indefinitely.2
What Abnormal Results Mean
There are different tests for hepatitis A and hepatitis B. A positive test is considered abnormal.
A positive test may mean:
- You currently have a hepatitis infection. This may be a new infection , or it may be an infection that you have had for a long time .
- You had a hepatitis infection in the past, but you no longer have the infection and can’t spread it to others.
Hepatitis A test results:
- IgM anti-hepatitis A virus antibodies, you have had a recent infection with hepatitis A
- Total antibodies to hepatitis A, you have a previous or past infection, or immunity to hepatitis A
Hepatitis B test results:
- Hepatitis B surface antigen : you have an active hepatitis B infection, either recent or chronic
- Antibody to hepatitis B core antigen , you have a recent or past hepatitis B infection
- Antibody to HBsAg : you have a past hepatitis B infection or you have received the hepatitis B vaccine and are unlikely to become infected
- Hepatitis B type e antigen : you have a chronic hepatitis B infection and you are more likely to spread the infection to others through sexual contact or by sharing needles
Antibodies to hepatitis C can most often be detected 4 to 10 weeks after you get the infection. Other types of tests may be done to decide on treatment and monitor the hepatitis C infection.
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Question 1 What Is The Clinical Indication For Hepatitis B Surface Antibody Quantitation
Hepatitis B surface antibody quantitation is used to determine hepatitis B immune status, ie, to determine if the patient has developed immunity against the hepatitis B virus. Such immunity may develop following exposure to the hepatitis B virus or its vaccine.
Patients at higher risk of exposure to the virus include:
- Infants born to infected mothers
- Sex partners of infected persons
- People with more than 1 sex partner in the last 6 months
- People with a history of sexually transmitted infection
- Men who have sex with men
- Injection drug users
- Household contacts of an infected person
- Healthcare and safety workers who have contact with blood and body fluids
- People who have lived or traveled in an area in which hepatitis B is common
- People who live or work in a prison
Testing is not recommended routinely following vaccination. It is advised only for people whose subsequent clinical management depends on knowledge of their immune status. These people include:
- Chronic hemodialysis patients
- Immunocompromised people, including those with HIV infection, hematopoietic stem-cell transplant recipients, and people receiving chemotherapy
- Infants born to women who test positive for the hepatitis B surface antigen
- Sex partners of people who test positive for the hepatitis B surface antigen
- Healthcare and public safety workers who have contact with blood or body fluids