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ED Program Dramatically Increases HCV Testing

July 25th, 2018

For years, public health officials have urged more widespread hepatitis C virus (HCV) testing, even outside the typical high-risk population. A new study shows how EDs can play a critical role.

Researchers created a nontargeted, opt‐out ED HCV screening and linkage-to-care program among patients at least 13 years of age undergoing phlebotomy for clinical purposes from November 2016 to January 2017. Clinicians were informed about the program through an electronic best practice advisory (BPA), which also generated order labels. Specimens were drawn in the ED for HCV antibody (Ab) and reflex confirmatory RNA tests. If tests were positive, patients were contacted to help them arrange outpatient medical visits. HCV screening was streamlined and made as efficient as possible for ED staff using information technology to build documentation of verbal informed consent into patients' electronic medical records.

Overall, HCV Ab tests were performed on 3,808 patients, a 6,950% increase from pre-program. Of those, 13.2% tested positive, with 97.8% of those undergoing a follow‐up RNA test. Ultimately, 292 patients were confirmed positive for active infection, an overall RNA positivity rate of 7.7%.

For the last six years, the CDC has promoted routine one-time HCV screening for individuals born between 1945 and 1965, in addition of testing for the high-risk cohort, including drug users. These authors noted that 53% of patients who tested positive for active infection in this special program were outside the CDC’s birth cohort for increased risk for HCV; additionally, 15.8% of this cohort did not report injection drug use.

The study team tried to link patients with active infections to follow-up care; appointments were scheduled for 102 patients, and 66 patients showed up for care visits, about 22% of those testing positive.