ED-Based Opt-Out, Universal HCV Screening May Play an Important Role in Surveillance

HCV test
HCV test
Opt-out, universal screening for hepatitis C virus (HCV) infection conducted in urban emergency departments revealed a high prevalence of anti-HCV in adult patients tested.

Opt-out, universal hepatitis C virus (HCV) screening conducted in emergency departments (EDs) can help identify previously unrecognized HCV infections, according to a study published in the MMWR Morbidity and Mortality Weekly Report.1

Increasing HCV-related morbidity and mortality, low rates of awareness among infected persons, and the advent of curative therapies has made identifying persons with HCV an urgent public health challenge.1 Targeted testing for HCV in EDs has been demonstrated to be a high-yield and effective intervention for identifying previously unrecognized infections, especially among persons born between 1945 and 1965. Researchers therefore conducted a retrospective study at 4 geographically diverse, urban academic EDs in the United States that involved the implementation of opt-out, universal HCV  testing at different times and using differing methodologies among patients who reported no history of HCV infection.

The researchers found that among 14,252 tests performed on unique patients, 1315 (9.2%) had positive test results for anti-HCV. The prevalence of positive results for HCV RNA at the combined ED sites was 5.7%, which is substantially higher than the estimated overall US prevalence of 0.95%.2 At the state level, the prevalence of positive results for HCV RNA as determined through ED testing ranged from threefold to fivefold higher than the upper-estimated prevalence in each respective state. The researchers also found that opt-out, universal HCV screening performed in EDs identified that nearly half (47.5%) of infections were among persons born after 1965.1

The authors concluded, “Given the high prevalence of positive results for HCV RNA identified among a younger, predominately white cohort known to be disproportionately affected by the opioid crisis, ED-based opt-out, universal HCV screening might play an important role in surveillance and combat of interrelated epidemics of opioid overdose and bloodborne viral infections through harm-reduction interventions and navigation to HCV treatment.”1

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


  1. Galbraith JW, Anderson ES, Hsieh Y-H, et al. High prevalence of hepatitis C infection among adult patients at four urban emergency departments — Birmingham, Oakland, Baltimore, and Boston, 2015–2017. MMWR Morbid Mortal Wkly Rep. 2020;69(19):569-574.
  2. Rosenberg ES, Rosenthal EM, Hall EW, et al. Prevalence of hepatitis C virus infection in US states and the District of Columbia, 2013 to 2016. JAMA Netw Open. 2018;1:e186371-14.