Urban Emergency Departments Play a Critical Role in Identifying Undiagnosed HCV Patients

An emergency department screening and testing program based on birth cohort screening and injectable drug use found a high prevalence of the hepatitis C virus antibody among the cohorts tested, and identified several barriers to clinical implementation of the process.

An emergency department (ED) screening and testing program based on birth cohort screening and injectable drug use found a high prevalence of the hepatitis C virus (HCV) antibody among the cohorts tested. The study, published in the Annals of Internal Medicine, identified several barriers to screening and lack of follow up among these individuals, which can be a big challenge for EDs.

The retrospective study conducted by clinicians at the Department of Emergency Medicine, Almeda Health System in Oakland, used data collected on 26,639 adults during a 6-month period. Only 9.7% (2581) of these adults completed HCV screening or diagnostic screening for HCV, and 10.3% (267) of those tested positive for the virus. Highest prevalence of the virus was observed among injectable drug users and homeless individuals. Other factors that influenced positivity included diagnostic testing, birth cohort, and gender (male).

Of the 267 patients who tested positive, 51% (137) had documentation of result disclosure and 67% (180) had confirmatory ribonucleic acid testing performed, of whom 70% (126) had a positive result. But follow-up among these patients was difficult—while 57 patients (of 126) were scheduled for follow-up appointments, less than 50% (30) showed up.

The authors believe that their study highlights the critical role played by EDs in HCV testing and identifying the undiagnosed population. But challenges with result disclosure, confirmatory testing, and linkage to care (follow-up) need to be overcome, they explain.

While the CDC recommends HCV screening for individuals born between 1945 and 1965 (baby boomers) and intravenous drug users, not many EDs follow the guidance, and based on the findings of the current study, there are several barriers with screening and follow-up that EDs would need to overcome in their clinical practice.

“We have a better than even chance of reaching many of the 3 million people who are infected since they tend to be heavy emergency department users already. It gives us a chance to connect these people to ongoing care at HCV clinics or elsewhere in the health care system,” said lead study author Douglas White, MD, in a statement.