Centers for Disease Control and Prevention Recommendations for Hepatitis C Testing: The Need to Adopt Universal Screening in an Appalachian Emergency Department

Abstract

Background The Centers for Disease Control and Prevention recommends screening baby boomers and high‐risk patients for hepatitis C virus (HCV); however, the incidence of HCV is rapidly increasing among younger populations, and screening is limited by access to care and risk factor assessment. The purpose of this study was to evaluate characteristics of HCV antibody‐positive (Ab+) and ribonucleic acid (RNA)‐confirmed‐positive patients identified via two screening models in an Appalachian emergency department (ED). Methods This was a retrospective cohort study of patients who screened HCV Ab+ in the ED from January 1 to October 31, 2018. Data were extracted, and comparative analyses were conducted between the risk‐based and the universal screening models. Results Overall, 444 patients screened HCV Ab+, with a median age of 39 years. From January to May 2018, the risk factor model identified 126 HCV Ab+ patients out of 3,014 screened (4%), whereas from June to October 2018, the universal model identified 318 HCV Ab+ patients out of 5,407 screened (6%; p < 0.001). A consistently large proportion of diagnoses were new (71%). There was no statistically significant decrease between the RNA‐confirmed‐positive patients during the risk factor model (76, 60%) and universal model (186, 58%) time periods (p = 0.72). The models had high rates of reported intravenous drug use, and the universal screening adoption was modest at 33%. Conclusion This study was the first to present characteristics of HCV Ab+ and RNA‐confirmed‐positive patients identified during the transition to a universal screening model in an Appalachian ED. Most diagnoses were new regardless of screening model, but more patients screened HCV Ab+, and a similar proportion were RNA‐confirmed‐positive, under the universal model. Given that adoption of universal screening was modest, and risk factors remained similar, future research should investigate how to more effectively implement a universal screening model on a wider scale to identify early infections.

Prevalence of Hepatitis C Virus Infection Identified From Nontargeted Screening Among Adult Visitors in an Academic Appalachian Regional Emergency Department

“…However, most existing literature on HCV screening in EDs has arisen from urban settings, and little has been known about HCV screening in ED’s serving largely rural regions, including Appalachia. Our study is consistent with a recent HCV screening study in a rural ED where most HCV Ab–positive patients were young and White, likely due to the high prevalence of PWID and opioid use disorder within the region [ 20 ].…”

Risk factors for hepatitis C virus infection at a large urban emergency department

“…While ED‐based, non‐targeted HCV screening programs have been shown to be successful in both academic and community settings, many emergency departments may not have the resources necessary to conduct universal screening 14,39 . However, targeted screening interventions are likely to be feasible even in EDs with fewer resources.…”

“…While ED-based, non-targeted HCV screening programs have been shown to be successful in both academic and community settings, many emergency departments may not have the resources necessary to conduct universal screening. 14,39 However, targeted screening interventions are likely to be feasible even in EDs with fewer resources. Thus, we believe that our methodology may be used as a model for developing local HCV risk factor profiles, which can be used to target high-risk ED patients in settings without universal screening protocols.…”

Contemporary Insights into Hepatitis C Virus: A Comprehensive Review

“…Additionally, universal screening significantly enhances the detection of HCV, which is particularly crucial given the often-silent progression of the infection [ 276 ]. The urgency for a universal screening protocol is emphasized by the increasing incidence of HCV, especially among younger populations, where the disease may otherwise go unnoticed until advanced stages [ 277 , 278 ]. The current availability of safe and cost-effective DAAs ensures that HCV can be treated efficiently following detection [ 279 ].…”