Improved HCV Screening Needed at Community Health Centers

Community health centers screen less than 10% of baby boomer patients (and more men than women) for hepatitis C, a much lower percentage than recommended by national guidelines revised in 2013, according to a recently published study.

Guidelines from the US Preventative Services Task Force recommend that all patients born between 1945 and 1965 be tested for the liver damaging hepatitis C virus. Identifying and treating patients early improves outcomes and slows transmission of the disease, note authors of the study published in the January issue of The Journal of the American Osteopathic Association.

"HCV screening can reduce health inequities due to undiagnosed, untreated infection," coauthor Erica Turse, DO, MPH, of the University of Mississippi Medical Center said in a news release. "Diagnosing this disease is a public health imperative and, as an osteopathic physician, I know that swift intervention is the best shot these patients have to avoid cirrhosis, carcinoma and end-stage liver disease."

If left untreated, chronic infection of hepatitis C can seriously damage the liver and lead to cirrhosis, liver cancer and the need for a liver transplant. Health officials estimate that there are close to 3 million people in the US who are chronically infected with the bloodborne virus. Many may not know it because they have no obvious symptoms, the release states.

Community health centers are a frontline resource for early screening of the virus and millions of people rely on them as a primary care safety net, states the release. The large scale review that looked for screening gaps among eligible patients was conducted by researchers from Nova Southeastern University College of Osteopathic Medicine, the University of Mississippi Medical Center and two Florida clinics.

The study aimed to determine the prevalence of hepatitis C infection screening according to the new UPSTF birth cohort guidelines among a large community health center population. In June 2013, the task force updated its guidelines to recommend one-time screening for people born from 1945 to 1965, often called baby boomers, whereas earlier guidelines were only for people at high risk for infection, the release states.

The updated recommendation applies to all asymptomatic adults (in the above specified age range) without unknown liver disease or functional abnormalities. It was made, in part, because of concerns for people who may have been exposed to the virus through transfusions before 1992 when screening for hepatitis C in the public blood supply was not standardized.

Researchers reviewed “de-identified” electronic health records data from 14 centers in several states. Patients were included in the analysis if they were born from 1945 to 1965, had visited one of the centers sometime during 2013 and had not been previously diagnosed with the virus.

The analysis found that only 8.3% of 60,722 eligible patients were screened for hepatitis C. Of the 5033 people screened, 51.3% were men and 48.7% were women. Women in every race and ethnic group were less likely to be screened than men, the release states.

The authors note that the findings highlight a need to improve hepatitis C infection screening for patients who visit community health centers. Earlier identification and treatment of patients could potentially reduce cost of health care associated with advanced disease, the article states.