Undiagnosed HIV and HCV Infection in a New York City Emergency Department, 2015

Abstract

Undiagnosed HCV was more prevalent than undiagnosed HIV in this population, suggesting that aggressive testing initiatives similar to those directed toward HIV should be mounted to improve HCV diagnosis.

The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

“…ICER values calculated from birth cohort and general population screening compared to no screening with ED seroprevalence varied over a broad range of estimates. Reference lines represent varying seroprevalence measures obtained from observational studies of HCV measured in different EDs 8‐10,21‐24. Shaded regions represent the 95% confidence intervals around each line of best fit.…”

“…Locally weighted smoothing was used to create trend lines through a scatterplot with their respective 95% confidence interval bands to observe the relationship between seroprevalence measures and the resulting incremental cost‐effectiveness ratios (ICERs) per screening strategy when compared to no screening. Seroprevalence measures from published observational studies across multiple EDs were used as reference values to demonstrate the potential cost‐effectiveness of a similar screening programme offered in different ED settings 8‐10,21‐24 Ranging Linkage to Care: Because the benefits of screening are lost without linkage to further care and treatment, univariate sensitivity analysis was performed varying the probability of linkage to care parameter.…”

“…EDs have consistently been identified as a ‘safety net’ of care for patients, serving as their gateway to further health services 7,8 . The ED patient population has also been associated with a higher burden of HCV infection when compared to the general population in both the United States and Canada 9‐11 . Screening initiatives within EDs have been associated with detection of newly diagnosed infections and an increase in the number of patients who are linked to timely care 12‐14 .…”

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

“…For example, a recent study found an HCV seroprevalence of 3.9% among patients visiting a New York City emergency department (ED), and 19.2% of those cases were previously undiagnosed. Among undiagnosed HCV cases in that study, 39.5% of cases would be missed through birth cohort screening . Gaps in screening may also exist in primary care specialties that mainly care for patients outside the birth cohort.…”

Escape from planned obsolescence: Hepatitis C, the cirrhotic liver, and clonal expansions

“…Many health organizations have made HCV elimination a priority, but too often the “test and treat” paradigm gets stalled after the first step. In a study from a New York City Emergency Department, 80% of the people testing positive for HCV RNA (the definitive biomarker of infection) already had a positive HCV RNA test in their medical record (Torian et al, 2018). Importantly, ∼70% of the HCV RNA–positive patients were born between 1945 and 1965 and thus are part of the baby boomer cohort (Torian et al, 2018).…”