scholarly journals Prevalence of Hepatitis C Virus Infection Identified from Non-Targeted Screening Among Adult Visitors in an Academic Appalachian Regional Emergency Department

2021 ◽  
Author(s):  
J Daniel Moore ◽  
James Galbraith ◽  
Roger Humphries ◽  
Jennifer R Havens
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Screening Program ◽  
Clinical Care ◽  
White Male ◽  
Hcv Infection ◽  
Primary Study ◽  
Opt Out ◽  
Hcv Testing

Abstract Study Objectives We describe the initial results of an adult academic emergency department (ED) non-targeted hepatitis C virus (HCV) screening program serving Appalachia, which is disproportionately affected by the opioid epidemic. Methods The study was a retrospective screening study of ED systematic, non-targeted, opt-out HCV testing outcomes from July 2018 through September 2020. Eligibility requirements for “non-targeted” HCV testing included: adults (greater than 17 years), verbally able to communicate, receiving blood work already as part of routine clinical care, and not opting-out of testing. For eligible individuals who did not opt-out of testing, an HCV antibody (Ab) test was performed. Reactive Ab tests were confirmed with reflexive HCV ribonucleic acid (RNA) testing. The primary study outcome was the characterization of HCV Ab and RNA prevalence. Results There were 75,722 unique adult visitors during the period studied. Of these, 54,931 individuals were verbally engaged regarding testing and did not opt-out. A total of 34,848 individuals received HCV Ab testing, with 3,665 patients (10.5%) having reactive results. RNA confirmatory testing was reflexively performed in all Ab positive patients, with 1,601 (50.3%) positive. The majority of HCV Ab and RNA positive patients were young, born after 1965, and were more likely to be White, male, Medicaid insured, and report a history of injection drug use. Conclusion ED non-targeted, opt-out testing can identify a high prevalence of HCV infection among adult visitors. HCV infection was disproportionately high among younger, White individuals, likely reflecting the escalating syndemic of opioid injection and HCV transmission in Appalachia.

scholarly journals Implementation and Preliminary Results of an Emergency Department Nontargeted, Opt‐out Hepatitis C Virus Screening Program

2018 ◽  
Vol 25 (11) ◽  
pp. 1216-1226 ◽  
Author(s):  
Elissa M. Schechter‐Perkins ◽  
Nancy S. Miller ◽  
Jon Hall ◽  
Joshua J. Hartman ◽  
David H. Dorfman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Screening Program ◽  
Preliminary Results ◽  
Opt Out ◽  
Virus Screening

Testing for Hepatitis C Virus Infection Among Adults Aged ≥18 in the United States, 2013-2017

2021 ◽  
pp. 003335492110472
Author(s):  
Hope King ◽  
J. E. Soh ◽  
William W. Thompson ◽  
Jessica Rogers Brown ◽  
Karina Rapposelli ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Hepatitis C Virus ◽  
Liver Disease ◽  
Hepatitis C ◽  
The United States ◽  
Hcv Infection ◽  
High School Education ◽  
Related Risk ◽  
Hcv Testing

Objective Approximately 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. The objective of our study was to describe demographic and socioeconomic characteristics, liver disease–related risk factors, and modifiable health behaviors associated with self-reported testing for HCV infection among adults. Methods Using data on adult respondents aged ≥18 from the 2013-2017 National Health Interview Survey, we summarized descriptive data on sociodemographic characteristics and liver disease–related risk factors and stratified data by educational attainment. We used weighted logistic regression to examine predictors of HCV testing. Results During the study period, 11.7% (95% CI, 11.5%-12.0%) of adults reported ever being tested for HCV infection. Testing was higher in 2017 than in 2013 (adjusted odds ratio [aOR] = 1.27; 95% CI, 1.18-1.36). Adults with ≥some college were significantly more likely to report being tested (aOR = 1.60; 95% CI, 1.52-1.69) than adults with ≤high school education. Among adults with ≤high school education (but not adults with ≥some college), those who did not have health insurance were less likely than those with private health insurance (aOR = 0.78; 95% CI, 0.68-0.89) to get tested, and non–US-born adults were less likely than US-born adults to get tested (aOR = 0.77; 95% CI, 0.68-0.87). Conclusions Rates of self-reported HCV testing increased from 2013 to 2017, but testing rates remained low. Demographic characteristics, health behaviors, and liver disease–related risk factors may affect HCV testing rates among adults. HCV testing must increase to achieve hepatitis C elimination targets.

scholarly journals 308. Slow Adoption of a Nurse-Driven Protocol for Universal Hepatitis C Virus Screening in a Hospital Emergency Department: Lessons Learned

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S165-S165
Author(s):  
Zainab Wasti ◽  
Dagan Coppock ◽  
Zsofia Szep ◽  
Tiffany Scott ◽  
Taneesa Franks ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Baby Boomers ◽  
Public Health Intervention ◽  
Lessons Learned ◽  
Seroprevalence Rate ◽  
Screening Protocol ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background In areas with a high prevalence of hepatitis C virus (HCV) infection, emergency department (ED) visits may provide unique opportunities for screening. The catchment area for Hahnemann University Hospital (HUH) has an HCV seroprevalence rate of >20%. However, limited data exist addressing HCV testing strategies in the ED. This study describes the experience of piloting a nurse-driven HCV screening protocol in an urban hospital ED. Methods A nurse-driven HCV screening protocol was developed and implemented on August 1, 2018. We performed a retrospective analysis of the protocol’s performance from July 1, 2018, through December 31, 2018. Patients who were evaluated in the ED and had blood collected were analyzed. We provided universal HCV screening regardless of age or risk factors. If HCV-positive by antibody screen and viral load confirmation, an attempt was made to link patients to care. Linkage was defined as having received an inpatient evaluation by either infectious diseases or hepatology physician. Results Among 20,705 unique patients seen in the ED, 7841 (38%) had blood work collected. 821 (10.5%) patients had HCV antibody testing. After the implementation of the nurse-driven protocol, the testing rate increased from 68/1340 (5.1%) to 753/6501 (11.6%). 260 Baby Boomers (born between 1945–1965) were screened, of which 60 (23.1%) had positive screens. 561 non-Baby Boomers were screened, of which 30 (5.4%) had positive screens. Barriers of implementing nurse-driven protocol were: (1) multiple steps of the ordering process in the electronic medical record (EMR), (2) the complexity of staff schedules, and (3) staff concerns regarding the disclosure of HCV test results. Among the patients who were diagnosed with chronic HCV, 60 % were linked to care for treatment. Conclusion We piloted a nurse-driven universal HCV testing protocol in the ED of a hospital with high HCV prevalence. Though the screening rate doubled, it was still low. We identified barriers that may be addressed to improve future screening rates. In areas with a high seroprevalence of HCV, universal screening may be an excellent public health intervention to identify asymptomatic HCV-infected patients. Disclosures All authors: No reported disclosures.

scholarly journals Addressing the disease burden of vertically-acquired hepatitis C virus (HCV) infection among opioid-exposed infants

2019 ◽  
Author(s):  
Stella Protopapas ◽  
Liza Bronner Murrison ◽  
Scott L Wexelblatt ◽  
Jason T Blackard ◽  
Eric S Hall
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
High Risk ◽  
Disease Burden ◽  
Hcv Infection ◽  
Control Analysis ◽  
Factors Associated ◽  
High Risk Infants ◽  
Urine Testing ◽  
Hcv Testing

Abstract Purpose This study aims to estimate the disease burden of vertically-acquired hepatitis C virus (HCV) in a large Midwestern hospital; and to identify factors associated with HCV diagnostic testing among high-risk infants. Methods Retrospective analysis of an infant cohort (n=58,427) born from 2014-2016 in the Greater Cincinnati region, where universal maternal urine testing is conducted at delivery to assess for intrauterine drug exposure (IUDE). Demographics and birth characteristics were analyzed among high-risk infants to identify factors associated with receiving HCV testing. A nested matched case-control analysis examined the association of pediatric HCV infection and IUDE. Results The HCV prevalence rate among high-risk infants who received testing was 3.6-5.2% of births. Approximately 66.7% of maternally-acquired HCV infections may be missed using current testing recommendations. Prenatal care had no significant effect (aOR 1.2 [95%CI 0.4-3.5]) on the odds of a high-risk infant receiving HCV testing. Opioid-exposed cases had an over 6-fold increase in the odds of HCV infection (aOR 6.2 [95%CI 2.3-16.6]) compared to non-opioid exposed infants. Conclusions IUDE was significantly associated with increased odds of pediatric HCV infection in this population. The gaps in pediatric HCV testing identified in this study, despite known risk level and maternal infection, suggest the need for increased focus on HCV identification in the pediatric population.

Hepatitis C Virus Screening Among Adolescents Attending a Drug Rehabilitation Center

2019 ◽  
Vol 9 (4) ◽  
pp. 437-441 ◽  
Author(s):  
Neil Dominic Fernandes ◽  
Swagata Banik ◽  
Nazha Abughali ◽  
Bonisha Sthapit ◽  
Neelab Abdullah ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
High Risk ◽  
Hcv Infection ◽  
Health Concern ◽  
High Risk Population ◽  
Drug Rehabilitation ◽  
Rehabilitation Center ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background Hepatitis C virus (HCV) infection has a strong association with intravenous drug use (IVDU). IVDU is a growing public health concern, even in the adolescent population. To our knowledge, there are no published HCV screening studies targeting high-risk adolescents who attend drug rehabilitation centers. This study was designed to determine the seroprevalence of HCV infection utilizing point-of-care (POC) testing at an adolescent drug rehabilitation center and gain a preliminary understanding of the acceptance rate for HCV screening in this high-risk population. Methods This single-center, observational study was conducted at a major drug rehabilitation center in northeast Ohio from July 2016 to June 2017. The consented adolescents who presented at the center were recruited to participate in HCV screening. The participants were administered a survey to assess their demographics and risk behavior profile followed by HCV testing utilizing a POC test. Results During the study period, 150 adolescents were admitted to the drug rehabilitation center, of whom 100 were approached and 85 agreed to participate. Forty percent of the participants (34/85) were females, and 78% (66/85) were white. HCV prevalence among participants was 5% (4/85), all of whom were females. History of heroin use was reported by 15% (13/85) and it was associated with HCV seropositivity; 100% (4/4) of all HCV-positive individuals reported the use of heroin vs only 11% (9/81) of HCV-negative individuals (P = .0004). Conclusions Our study showed a high prevalence of HCV among adolescents attending a drug rehabilitation center with high acceptance of POC HCV testing.

scholarly journals Using the electronic medical record to increase testing for HIV and hepatitis C virus in an Appalachian emergency department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen N. Burrell ◽  
Melinda J. Sharon ◽  
Stephen Davis ◽  
Judith Feinberg ◽  
Elena M. Wojcik ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Best Practice ◽  
Linkage To Care ◽  
Patient Navigators ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators. Methods EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%. Conclusion HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.

An opt-out approach to hepatitis C virus testing in English prisons: the literature underpinning the policy

2021 ◽  
Vol 30 (20) ◽  
pp. 1158-1164
Author(s):  
Kathryn Jack
Keyword(s):  
Public Health ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Public Health Policy ◽  
World Health ◽  
Opt Out ◽  
The World ◽  
Public Health Threat ◽  
Hcv Testing ◽  
Virus Testing

Background: The World Health Organization's aim to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030 is dependent on testing people. HCV prevalence is higher in prisons, so to increase test uptake an ‘opt-out’ approach to blood-borne virus testing in English and Welsh prisons was introduced. Aims: This literature review examines the evidence behind the introduction of this public health policy. Methods: Four healthcare databases were searched for publications between January 2000 and February 2020 on the opt-out approach to blood-borne virus testing in prisons. Findings: Sixteen studies published between 2009 and 2019 were included. Analysis of their findings showed that an increase in HCV test uptake in prisons occurs when an opt-out approach is used in combination with additional interventions. Contextual differences between UK and US prisons may affect HCV test uptake. Conclusion: An opt-out approach to HCV testing in prisons can increase test uptake as part of a complex of interventions.

scholarly journals Hepatitis C Virus (HCV) diagnosis, epidemiology and access to treatment in a UK cohort

2017 ◽  
Author(s):  
Emily Adland ◽  
Gerald Jesuthasan ◽  
Louise Downs ◽  
Victoria Wharton ◽  
Gemma Wilde ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Viral Load ◽  
Hepatitis C ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Clinical Care ◽  
Virologic Response ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Direct Acting Antiviral

ABSTRACTBackgroundAs direct acting antiviral (DAA) therapy is progressively rolled out for patients with hepatitis C virus (HCV) infection, careful scrutiny of HCV epidemiology, diagnostic testing, and access to care is crucial to underpin improvements in delivery of treatment.MethodsWe performed a retrospective study of HCV infection in a UK teaching hospital to evaluate the performance of different diagnostic laboratory tests, to describe the population with active HCV infection, and to determine the proportion of these individuals who access clinical care.ResultsOver a total time period of 33 months between 2013 and 2016, we tested 38,510 individuals for HCV infection and confirmed a new diagnosis of active HCV infection (HCV-Ag+ and/or HCV RNA+) in 359 (positive rate 0.9%). Our in-house HCV-Ab test had a positive predictive value of 87% when compared to repeat HCV-Ab testing in a regional reference laboratory, highlighting the potential for false positives to arise based on a single round of antibody-based screening. Of those confirmed Ab-positive, 70% were HCV RNA positive. HCV-Ag screening performed well, with 100% positive predictive value compared to detection of HCV RNA. There was a strong correlation between quantitative HCV-Ag and HCV RNA viral load (p<0.0001). Among the 359 cases of infection, the median age was 37 years, 85% were male, and 36% were in prison. Among 250 infections for which genotype was available, HCV genotype-1 (n=110) and genotype-3 (n=111) accounted for the majority. 117/359 (33%) attended a clinic appointment and 48 (13%) had curative treatment defined as sustained virologic response at 12 weeks (SVR12).ConclusionsHCV-Ab tests should be interpreted with caution as an indicator of population prevalence of HCV infection, both as a result of the detection of individuals who have cleared infection and due to false positive test results. We demonstrate that active HCV infection is over-represented among men and in the prison population. A minority of patients with a diagnosis of HCV infection access clinical care and therapy; enhanced efforts are required to target diagnosis and providing linkage to clinical care within high risk populations.ABBREVIATIONSDAADirect Acting AntiviralELISAEnzyme linked immunosorbent assayHCVHepatitis C VirusHCV-AbIgG antibody to Hepatitis C virusHCV-AgHepatitis C virus core antigenHCV RNAHepatitis C ribonucleic acid (viral load)MSMmen who have sex with menNATnucleic acid testingPCRpolymerase chain reaction (test for viral load)PPVpositive predictive valuePWIDpeople who inject drugsSDGSustainable Development GoalsSVRsustained virologic responseWHOWorld Health Organisation

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