Non-Targeted Hepatitis C Virus Screening Helps Identify Potential Missed Cases

A non-targeted hepatitis C virus (HCV) screening program could help identify more infections in regions with high HCV burden.

A team led by Cody A. Chastain, MD, Department of Medicine, Vanderbilt University Medical Center evaluated the performance of non-targeted HCV screening in emergency departments and other healthcare settings to identify HCV infection and HCV care to improve.

Non-Target Screenings

A non-target HCV screening and linking to care program was implemented at 10 facilities in various healthcare facilities throughout the southern Appalachia, including emergency departments, outpatient clinics, and inpatient units. Southern Appalachia is known as an area of ​​high HCV burden.

“Many potential methods have been proposed to achieve widespread screening of the US adult population, including routine non-targeted HCV testing in emergency departments, inpatient hospital units, and outpatient departments,” the authors wrote. “However, the usefulness of non-targeted HCV screening, defined as testing for HCV infection regardless of the patient’s symptoms and known risk factors for HCV infection, in these settings remains incomplete.”

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The new program used non-targeted screening methods, in which patients were offered HCV testing without presenting clinical symptoms or identifying risk factors for HCV infection.

Implementation of the screening program

In the multi-center, multi-year surveillance program, researchers examined data from 195,152 patients screened for HCV between 2017 and 2019 after conducting a screening program at the time of patient access to healthcare.

The researchers tested serum samples for each patient for HCV antibodies. When a patient tested positive, researchers used HCV ribonucleic acid (RNA) testing to confirm active infection.

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Patients with positive results were connected to further HCV care. Overall, 8.5% (n=16,529) of the screened patients were positive in the antibody test. Additional RNA testing showed that 5.2% of patients screened and 61.3% of antibody test positive patients (n=10,139) were positive.

Of the positive patients, 57% (n=5778) were successfully linked to HCV care.

Investigators also looked at data from specific locations.

83,645 patients were screened in emergency departments, 10.8% (n=9060) were HCV antibody test positive. Of this group, 6.3% (n = 5243) were confirmed positive with the RNA test.

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However, in the group positive by RNA testing in the ED, the link to care was only 44.1%, compared to 67.6% for patients in outpatient departments (P <0.01) and 50.9% for patients in inpatient units (P <0.01).

“Untargeted HCV screening in the acute care setting can identify large numbers of people with HCV infection,” the authors write. “To maximize the utility of these screening programs, future work is needed to develop best practices that consistently associate these patients with HCV care.”

The study, Non-targeted hepatitis C virus screening in acute care facilities in the Southern Appalachian region, was published online in Journal of the American College of Emergency Physicians Open.

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