Expanded Hepatitis C Testing in Emergency Departments Shows Success

Expanding testing in emergency departments for hepatitis C virus (HCV) beyond typical high-risk populations was found to be an effective measure to screen undiagnosed patients who may have otherwise gone without treatment, according to a study published in Academic Emergency Medicine.

The analysis, conducted in the emergency department at Boston Medical Center (BMC), expanded the facility’s monthly HCV screening rate by more than 6000% by screening for the virus whether or not patients had a perceived risk for the disease.

"Our findings indicate that if we had only tested the high risk birth cohort, there would have been 268 missed cases and 155 missed active infections," lead author Elissa Perkins, MD, MPH, emergency medicine physician at BMC, said in a press release. "Physicians and patients should consider screening for HCV outside of the typical high-risk groups to ensure appropriate HCV diagnosis."

A guidance issued in 2012 by the Centers for Disease Control and Prevention (CDC) suggested screening for HCV among baby boomers, those born between 1945 and 1965. The CDC also indicated the need for targeted testing among injection drug users and other high-risk populations. The study authors noted that the guidance had a limited effect on individuals born after 1965. Meanwhile, the ongoing opioid epidemic led to a rise in injection drug use and, subsequently, a spike in new HCV infections, according to the study.

The study authors examined data from a 3-month period between November 2016 and January 2017, which involved HCV testing on 3808 patients in the BMC emergency department. This totaled to an average HCV screening rate of 1269 per month, a 6950% jump from the prior year’s monthly average of 18 HCV screenings. The expanded screening included patients who were at least 13 years of age, were already receiving blood testing for clinical purposes, and who authorized HCV antibody and reflex confirmatory RNA tests, according to the study.

Among those screened for the virus, 504 individuals tested positive for HCV, of whom 97% received a follow up RNA test. The study showed an overall HCV positivity rate of nearly 8%. Among individuals confirmed for an active HCV infection, 155 did not meet the criteria for increased risk of HCV.

Following testing, the researchers sought to connect HCV-positive individuals with follow-up care, with 66 patients making an appointment.

"Those 66 patients that were connected to care through our program demonstrate the importance of increasing screening rates for HCV infection," Perkins said.