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High Prevalence of HCV Found via Urban ED Screening

A new screening and diagnostic testing program for hepatitis C virus infection at an urban ED showed that the infection was prevalent among those with a history of injection drug use and many lacked general knowledge of the infection, according to published findings in Annals of Emergency Medicine.

“Given skyrocketing rates of injection heroin use around the country, we expect the already high rates of hepatitis C infection to explode,” study author Douglas White, MD, of Highland Hospital, Alameda Health System in Oakland, Calif., said in a press release. “Intervention by emergency departments, in the form of screening and referral for treatment, could help slow the spread of this potentially deadly, communicable disease.”

White and colleagues conducted a retrospective cohort study using data of adults who visited the ED at Highland Hospital of the Alameda Health System collected over a 6-month period. The ED at Highland supports and serves mainly adult patients of racial and ethnic minorities, according to the research.

“In addition to the myriad public health functions they already perform, urban emergency departments may play an important role as safety net providers for HCV screening,” White said in the release. “We have a better than even chance of reaching many of the three million people who are infected since they tend to be heavy emergency department users already. It gives us a chance to connect these people to ongoing care at HCV clinics or elsewhere in the health care system.”

Of 26,639 adults, 2,581 HCV antibody tests were performed. Of these, 2,028 were screening tests (79%) and 553 were diagnostic tests (21%).

Overall, researchers found HCV positivity among 10.3% of patients (n = 267). According to the release, of the 10.3% of patients with HCV, 70% were found to be chronically infected and only 24% who were positive had prior knowledge of the infection.

In addition, 51% of the HCV-positive patients (n = 137) had documentation of recent disclosure and 67% had confirmatory ribonucleic acid testing performed (n = 180). In the patients who underwent ribonucleic acid testing, 70% tested positive (n = 126). Fifty-seven percent of the 126 patients were scheduled for follow-up appointments. However, only 30 attended their follow-up.

The study found the following factors to be associated with being positive for HCV: injection drug use (38.4%), homelessness (25.5%), diagnostic testing (14.8%), birth cohort (13.7%) and male sex (12.4%).

The researchers concluded: “Challenges encountered with hepatitis C virus screening included result disclosure, confirmatory testing, and linkage to care. Our results warrant continued efforts to develop and evaluate policies for ED-based hepatitis C virus screening.” – by Melinda Stevens

Disclosures: White reports receiving grant support from Gilead Sciences. Please see the full study for a list of all other authors’ relevant financial disclosures.