- 1Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA.
- 2Department of Biostatistics Vanderbilt University Medical Center Nashville Tennessee USA.
- 3Population Health Norton Healthcare Louisville Kentucky USA.
- 4Department of Emergency Medicine University of Kentucky Lexington Kentucky USA.
- 5Consultant and Program Director Appalachia Regional Healthcare Hazard Kentucky USA.
- 6Department of Medicine University of Louisville Louisville Kentucky USA.
- 7Knox County Health Department Knoxville Tennessee USA.
- 8Department of Medicine Carilion Clinic Roanoke Virginia USA.
- 9Madison County Health Department Madison County North Carolina USA.
- 10Department of Emergency Medicine West Virginia University Morgantown West Virginia USA.
- 11Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA.
- 12Department of Emergency Medicine Vanderbilt University Medical Center and the Geriatric Research, Education, and Clinical Center Tennessee Valley Healthcare Center Nashville Tennessee USA.
- 13Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research Vanderbilt University Medical Center Nashville Tennessee USA.
Objectives: The objective of this study was to evaluate the performance of non-targeted hepatitis C virus (HCV) screening in emergency departments (EDs) and other healthcare settings in terms of patients identified with HCV infection and linked to HCV care.
Methods: In the Southern Appalachian region of the United States, we developed non-targeted HCV screening and linkage-to-care programs in 10 institutions at different healthcare settings, including EDs, outpatient clinics, and inpatient units. Serum samples were tested for HCV antibodies, and if positive, reflexed to HCV ribonucleic acid (RNA) testing as a confirmatory test for active infection. Patients with positive RNA tests were contacted to link them to HCV care.
Results: Between 2017 and 2019, among 195,152 patients screened for HCV infection, 16,529 (8.5%) were positive by antibody testing, 10,139 (5.2% of screened patients and 61.3% of patients positive by antibody test) were positive by RNA testing, and 5778 (3.0% of screened patients and 57.0% of patients positive by RNA test) were successfully linked to HCV care. Among 83,645 patients screened in EDs, 9060 (10.8%) were positive by HCV antibody, and 5243 (6.3%) were positive by RNA test. Among patients positive by RNA testing, linkage to care was lower for patients screened in the ED (44.1%) compared with outpatient clinics (67.6%) (P < 0.01) and inpatient units (50.9%) (P < 0.01).
Conclusions: Non-targeted HCV screening in acute care settings can identify large numbers of people with HCV infection. To optimize the utility of these screening programs, future work is needed to develop best practices that consistently link these patients to HCV care.