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Background: The second-generation hepatitis C virus (HCV) enzyme immunoassay (EIA 2), an antibody-detection test, has high sensitivity and is one of the recommended screening tests for detecting HCV infection in the United States. However, its sensitivity among oncology patients is unknown. Objective: Assess the EIA 2 sensitivity among a group of oncology patients at a Nebraska clinic where an HCV outbreak occurred during 2000-2001 using nucleic acid testing (NAT) and recombinant immunoblot assay (RIBA) as the gold standards. Study design: Serum specimens were collected from patients 16 months after transmission had stopped. We tested the specimens using EIA 2 (Abbott HCV EIA 2.0), a NAT assay based on transcription-mediated amplification (TMA) (Gen-Probe TMA assay) and RIBA (Chiron RIBA ® HCV 3.0 SIA). HCV infection was defined as a positive RIBA or TMA test in an oncology patient. Alanine aminotransferase (ALT) levels were determined in EIA 2-negative/TMA-positive samples. Results: A total of 264 samples were included in the study. We identified 92 HCV infections, 76 of which were Abbott EIA 2 positive. Abbott EIA 2 sensitivity was 83% (76/92), lower than that reported among healthy adults (90%) (p = 0.01) and poor sensitivity was associated with receipt of chemotherapy during the outbreak period (p = 0.02). Only 1 (6%) of the 16 EIA 2-negative cases had elevated ALT. Conclusions: In this study, EIA 2 sensitivity among oncology patients was lower than that previously reported among immunocompetent persons. Impaired antibody production related to cancer and/or chemotherapy might explain the reduced sensitivity. These findings indicate that, when assessing HCV status in oncology patients, a NAT test should be routinely considered in addition to EIA.

The measurement community is often confronted with questions regarding appropriate uses for test scores, particularly in the context of high-stakes decisions and the consequences that may emerge from these uses. The use of test scores in education to make individual decisions about students' proficiency or graduation eligibility may not be perceived to be as critical as the decisions made within admissions, licensure, certification, or employment testing; however, these are all areas that are often characterized as high-stakes uses.Intelligence tests are often administered early in a student's education, with scores being used to identify students for special education and other programs. For example, students who earn high scores on an intelligence test may be identified for gifted programs, whereas students who score lower may be identified for remedial or special education programs. Although the test scores are perhaps not intended for high-stakes purposes, students who are identified for these programs may receive additional attention or services on the basis of these scores. For example, a woman in Tacoma, Washington, An earlier version of this chapter was presented as a paper at the 2007 annual meeting of the National Council on Measurement in Education. The authors are grateful for feedback provided by Ellen Forte and Thanos Patelis on that earlier version.

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