Non-targeted, opt-out testing for hepatitis C virus (HCV) infection can be successfully implemented in the emergency department (ED) setting, and this can help to diagnose patients outside of traditional risk groups, according to study results published in Academic Emergency Medicine.
However, the findings indicated that an ED population can be difficult to engage in follow-up care. A structured interdisciplinary program is needed in order to link newly-diagnosed patients infected with HCV with further treatment.
The study analyzed a nontargeted, opt-out ED HCV screening and linkage-to-care program for participants age >13 who underwent phlebotomy for clinical purposes from November 2016 through January 2017. A multi-purpose Best Practice Advisory alerted clinicians to the program and generated order labels.
Specimens were drawn in the ED for HCV antibody (Ab) and reflex confirmatory RNA tests were performed on participants who authorized testing. If a participant was HCV RNA+, public health navigators attempted to contact them and arrange outpatient visits.
Over the study period, HCV Ab tests were performed on 3808 participants, an increase of 6950% from pre-program implementation. Of these tests, 13.2% were positive (n=504), and 97.8% (n=493) of those participants had a follow-up RNA test.
After follow-up testing, 292 participants had confirmed active infection. Of these participants, 53% (n=155) were outside the Centers for Disease Control and Prevention (CDC) birth cohort for HCV, including 15.8% of RNA+ participants who did not report injection drug use.
There were documented linkage attempts for 76.4% (n=223) of RNA+ participants. Of these, 38% (n=102) scheduled outpatient appointments and 66 attended those appointments.
This study was funded by a grant from Gilead Sciences. Please refer to original text for full list of author disclosures.
Schechter-Perkins EM, Miller NS, Hall J, et al. Implementation and preliminary results of an emergency department nontargeted, opt-out hepatitis C virus screening program [published online May 31, 2018]. Acad Emerg Med. doi:10.1111/acem.13484