Attitudes, practices and perceived barriers to hepatitis C screening among medical residents at a large urban academic medical center

Winetsky, Daniel; Zucker, Jason; Carnevale, Caroline; Theodore, Deborah; Scherer, Matthew; Sani, Fereshteh; Elkington, Katherine S.; Cohall, Alwyn; Sobieszczyk, Magdalena E.; Gordon, Peter; Olender, Susan

doi:10.1111/jvh.13181

Cited by 6 publications

(8 citation statements)

References 8 publications

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“…15 The majority of doctors also recognize the importance of screening, but acknowledge that it is poorly performed due to time and resource limitations. 16 Sustainable ED screening must not interfere with core service provision. 17 The SEARCH service utilization of opt-out consent and automation using samples already drawn appears to be a superior approach.…”

Section: Discussionmentioning

confidence: 99%

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Prince

Pipicella

Fraser

et al. 2020

Journal of Viral Hepatitis

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The World Health Organization has set ambitious viral hepatitis elimination targets; however, difficulties in identifying and engaging patients remain. The emergency visit is an opportunity for enhanced linkage to care (LTC). We assessed the effectiveness of an automated Emergency Department (ED) screening service in identifying patients with hepatitis C (HCV) and achieving LTC. A retrospective evaluation was undertaken, analysing the first 5000 patients screened through an automatic Australian service termed ‘Screening Emergency Admissions at Risk of Chronic Hepatitis’ (SEARCH). Screening was performed for those recommended in the Australian national testing policy, specifically overseas born (OB) and Aboriginal or Torres Strait Islanders (ATSI). Healthcare worker education, patient information materials and opt‐out informed consent were used to test sera already collected for biochemistry assays. 5000 of 5801 (86.2%) consecutive eligible patients were screened (OB: 4778, ATSI: 222) from 14 093 ED presentations. HCV antibody was positive in 181 patients (3.6%); 51 (1.0%) were HCV RNA positive. Of 51 HCV RNA–positive patients, 12 were new diagnoses, 32 were ‘re‐diagnoses’ (aware but lost to follow‐up [LTFU]), and 7 were previously known but treatment contraindicated. LTC was successful in 38 viraemic patients (7 deceased, 4 LTFU, 1 treatment ineligible and 1 declined). Of RNA‐negative patients, 75 were previously treated and 49 had presumed spontaneous clearance. Opt‐out consent was acceptable to all patients and staff involved. ED screening can lead to additional diagnosing and ‘re‐diagnosing’ of HCV, with high rates of LTC. Opt‐out consent and automation removed major obstacles to testing.

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Section: Discussionmentioning

confidence: 99%

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Prince

Pipicella

Fraser

et al. 2020

Journal of Viral Hepatitis

View full text Add to dashboard Cite

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“…[ 49 ] Improving provider knowledge of HCV, and expanding options for nonspecialist providers to prescribe antivirals have the potential to improve screening rates. [ 49 ]…”

Section: Discussionmentioning

confidence: 99%

“…Florida Medicaid also requires that antiviral prescriptions are provided in consultation with specialized clinicians (eg, hematologist, gastroenterologist, infectious disease specialist or transplant specialist), which may be challenging for residents of medically underserved areas [48] . Providers who are not specialized report low competency related to HCV management and limited expertise in treating high-risk patients, resulting in misperceptions and stigma towards patients [49] . Improving provider knowledge of HCV, and expanding options for nonspecialist providers to prescribe antivirals have the potential to improve screening rates [49] …”

Section: Discussionmentioning

confidence: 99%

Do patients at high risk for Hepatitis C receive recommended testing? A retrospective cohort study of statewide Medicaid claims linked with OneFlorida clinical data

et al. 2021

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Hepatitis C virus (HCV) infection is a leading risk factor for hepatocellular carcinoma. We employed a retrospective cohort study design and analyzed 2012–2018 Medicaid claims linked with electronic health records data from the OneFlorida Data Trust, a statewide data repository containing electronic health records data for 15.07 million Floridians from 11 health care systems. Only adult patients at high-risk for HCV (n = 30,113), defined by diagnosis of: HIV/AIDS (20%), substance use disorder (64%), or sexually transmitted infections (22%) were included. Logistic regression examined factors associated with meeting the recommended sequence of HCV testing. Overall, 44.1% received an HCV test. The odds of receiving an initial test were significantly higher for pregnant females (odds ratio [OR]1.99; 95% confidence interval [CI] 1.86–2.12; P < .001) and increased with age (OR 1.01; 95% CI 1.00–1.01; P < .001).Among patients with low Charlson comorbidity index (CCI = 1), non-Hispanic (NH) black patients (OR 0.86; 95% CI 0.81–0.9; P < .001) had lower odds of getting an HCV test; however, NH black patients with CCI = 10 had higher odds (OR 1.41; 95% CI 1.21–1.66; P < .001) of receiving a test. Of those who tested negative during initial testing, 17% received a second recommended test after 6 to 24 months. Medicaid-Medicare dual eligible patients, those with high CCI (OR 1.14; 95% CI 1.11–1.17; P < .001), NH blacks (OR 1.93; 95% CI 1.61–2.32; P < .001), and Hispanics (OR 1.49; 95% CI 1.08–2.06; P = .02) were significantly more likely to have received a second HCV test, while pregnant females (OR 0.71; 95% CI 0.57–0.89; P = .003), had lower odds of receiving it. The majority of patients who tested positive during the initial test (97%) received subsequent testing. We observed suboptimal adherence to the recommended HCV testing among high-risk patients underscoring the need for tailored interventions aimed at successfully navigating high-risk individuals through the HCV screening process. Future interventional studies targeting multilevel factors, including patients, clinicians and health systems are needed to increase HCV screening rates for high-risk populations.

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“…We assessed attitudes and practices around sexual health with a focus on perceived barriers to the provision of sexual health services (i.e., HIV screening, STI screening, provision of pre and post-exposure prophylaxis services and hepatitis C virus screening). Responses regarding hepatitis C virus testing have been previously reported 16 . For purposes of this study, routine STI screening was defined as “laboratory-based screening for patients over age 13 in the absence of symptoms,” and STIs were limited to, gonorrhea, chlamydia and syphilis.…”

Section: Methodsmentioning

confidence: 99%

“…Responses regarding hepatitis C virus testing have been previously reported. 16 For purposes of this study, routine STI screening was defined as "laboratory-based screening for patients over age 13 in the absence of symptoms," and STIs were limited to, gonorrhea, chlamydia and syphilis.…”

Section: Questionnairementioning

confidence: 99%

Attitudes and Perceived Barriers to Sexually Transmitted Infection Screening Among Graduate Medical Trainees

et al. 2021

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Graduate medical training is an opportune time to improve provider delivery of sexually transmitted infection (STI) screening. A survey of trainees found that the majority feel STI screening is their job but identified barriers to successful screening. Training that intentionally address service-specific barriers will be valuable in ending the STI epidemic.R ates of sexually transmitted infections (STIs) in the United States and New York City (NYC) have been increasing since 2014. 1,2 Untreated STIs account for substantial healthcare costs and may lead to further health complications; some, such as syphilis and gonorrhea, are a reliable marker of human immunodeficiency virus (HIV) acquisition. [3][4][5] Currently, the United States Preventive Services Task Force recommends routine gonorrhea and chlamydia screening for sexually active women 24 years or younger and older women who are at increased risk of HIV. 6 The United States Centers for Disease Control and Prevention recommend broader routine screening for gonorrhea and chlamydia, including in men who have sex with men, individuals on pre-exposure prophylaxis, persons living with HIV, and young men in high prevalence clinical settings. 7 Sexually transmitted infections are frequently asymptomatic; consequentially, risk-based screening can limit the clinical and public health impact of STI screening. 8,9 Additionally, patient stigma may affect STI risk factor disclosure, and provider stigma and discomfort may result in incomplete sexual history-taking, STI testing and treatment. 10,11 Strategies to reverse STI trends will require expansion of routine STI testing and treatment beyond sexual health service platforms and integration into other health services. 12 Integrating sexual and reproductive health (SRH) into other health services poses challenges at many health-system levels including the provider level. 10,11,13 Graduate medical education, in which resident physicians complete mentored-training, is an opportunity to improve provider delivery of STI screening and treatment as physicians establish medical practices that continue throughout their professional careers. 14,15 Because residents are "durably imprinted" during this training period, incorporating STI screening and treatment into the training curriculum can support future practices like the identification, management, and prevention of STIs, their sequelae, and other coinfections like HIV.

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Attitudes, practices and perceived barriers to hepatitis C screening among medical residents at a large urban academic medical center

Cited by 6 publications

References 8 publications

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or ‘re‐diagnose’ infections is effective in Australia

Do patients at high risk for Hepatitis C receive recommended testing? A retrospective cohort study of statewide Medicaid claims linked with OneFlorida clinical data

Attitudes and Perceived Barriers to Sexually Transmitted Infection Screening Among Graduate Medical Trainees

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