Assessing the Effectiveness of Strategies in US Birth Cohort Screening for Hepatitis C Infection

Abstract

Chronic hepatitis C infection in the USA is a highly morbid condition and current guidelines recommend one-time screening among the birth cohort . Understanding strategies to optimize screening can help inform future hepatitis C virus (HCV) screening guidelines. A focused literature search was performed using PubMed and manual abstract review from major hepatology conferences over the past 2 years. The search strategy involved using Medical Subject Headings terms for hepatitis C, screening, birth cohort, baby boomers, and 1945-1965. The review was limited to data from the USA. A total of 327 articles were identified and 36 abstracts were included, with studies published between 2012-2019. Strategies including clinician education, electronic medical record alerts, reflex HCV RNA testing, point-of-care testing, multisite (outpatient, inpatient, emergency department, endoscopy suite) initiatives, direct patient solicitation, and utilization of non-physician providers have increased HCV screening rates. However, broad implementation remains less than optimal. Barriers include lack of patient acceptance to screening and engagement in the HCV care cascade. The Veterans Affairs Healthcare System has achieved higher birth cohort screening rates through an integrated approach requiring high-level engagement by leadership and institutional commitment. Multiple strategies for increasing birth cohort screening have been successful, but overall rates of HCV screening remain low. These strategies can inform public health efforts to implement emerging national recommendations for expansion of HCV screening to all U.S. adults age 18 or older.

Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial

“…Interestingly, the rate of viral load positivity among screened patients who did not have patient portal access was 1.0%, suggesting this population might be at higher risk. Further research is needed for these approaches in other clinical populations 38…”

Sustained and cumulative impact of an electronic medical record‐based alert on a hepatitis C birth cohort screening programme

“…Our study demonstrates the critical role of an EMR‐based alert for the successful pursuit of a system‐wide baby boomer Hepatitis C screening programme. Similar to many other institutions in the United States, pre‐BPA screening rates by primary care providers were low in our healthcare system 4 . Strikingly, the implementation of a simple alert was followed by a six to tenfold increase in screening rates, which in turn resulted in a sustained and cumulative reduction in the number of screening‐naïve patients.…”

“…Routine HCV antibody testing of birth cohort patients was endorsed by the CDC and the USPSTF nearly one decade ago 1,2 . Despite these recommendations, screening rates in the United States have remained low, 3 prompting a variety of interventions to increase screening and uptake rates in the target population 4 . We recently reported the short‐term results of a system‐wide, electronic medical record‐based best practice alert (BPA).…”

“…1,2 Despite these recommendations, screening rates in the United States have remained low, 3 prompting a variety of interventions to increase screening and uptake rates in the target population. 4 We recently reported the short-term results of a system-wide, electronic medical record-based best practice alert (BPA). We found a significant increase in screening rates (SR) in response to the alert.…”

Key Elements on the Pathway to HCV Elimination: Lessons Learned From the AASLD HCV Special Interest Group 2020

“…The use of electronic prompt for clinicians increases by 3‐fold the likelihood of clinicians ordering tests for patients recommended for HCV screening. ( 8 ) Other effective strategies include reflex RNA testing of anti‐HCV+ specimens, training of clinicians to test and treat HCV infection, patient navigators to assist patients through the testing and treatment process, and access to HCV medications. The lessons learned can be applied to the scale‐up of HCV testing to reach new target populations.…”