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HCV testing remains low among baby boomers, awareness needed

Despite a recommendation from the United States Preventive Services Task Force in 2013 for one-time hepatitis C testing among baby boomers, only 13.8% reported testing in 2015, according to a survey conducted by the American Cancer Society.

“The proportion of people who are tested for HCV is pretty low. ... We estimated that 76.2 million baby boomers were eligible for HCV testing in 2015 but only 10.5 million reported receiving HCV testing,” Stacey A. Fedewa, PhD, from the Surveillance and Health Services Research at the American Cancer Society, told HCV Next. “One of the issues is that people might not be visiting their doctor or they are visiting, but they have other comorbidities so HCV testing might not be on the radar for the physician or the patients.”

Though slight, self-reported HCV testing rates did increase from 12.3% in the 2013 baseline National Health Interview Survey to 13.8% in 2015 (P = .013), according to the survey.

Comparing within the survey population, prevalence ratios (PR) showed privately insured adults had lower prevalence of HCV testing than those with combined Medicare/Medicaid coverage (PR = 1.83; 95% CI, 1.32-2.53), those with Medicaid only (PR = 1.35; 95% CI, 1.04-1.76) or those with military insurance (PR = 1.62; 95% CI, 1.16-2.26). Men reported higher rates of testing than women (PR = 1.25; 95% CI, 1.08-1.44). Those who lived with someone who had hepatitis also reported higher rates of testing (PR = 2.44; 95% CI, 2.01-2.96).

Those with an education level equivalent to a high school diploma or less reported lower HCV testing rates than those who held college degrees (PR = 0.58; 95% CI, 0.48-0.72 and PR = 0.63; 95% CI, 0.48-0.82, respectively).

“Reasons for the overall slow uptake of testing may include barriers to preventive care; unapparent symptoms; lack of awareness of the need to be tested among patients, who may not be fully covered by insurers; and lack of physician awareness of the USPSTF recommendations,” the authors wrote.

They attributed the higher prevalence in the military-insured population to continual testing within the Veterans Health Administration and the increased prevalence in Medicare and Medicaid populations to more prevalent risk factors for HCV. They speculated awareness about testing and more barriers to care prohibit those with lower education levels and no insurance from obtaining HCV testing.

“It’s important for physicians in public health to increase awareness,” Fedewa said. “Other health systems like single hospitals or safety net clinics where they have made a concerted effort to increase testing. ... That systematic approach may help.”

The study cited 90% testing rates in a safety net clinic and an increase from 47% to 88% in New York State after interventions were implemented.

From an American Cancer Society perspective, Fedewa said, “A lot of cancers have been declining in recent decades, however there are some cancers that are actually increasing and liver cancer is one of them. HCV is a major risk factor for liver cancer so that is why we are looking more into HCV testing and continuing to monitor liver cancer.” – by Katrina Altersitz

Disclosure : Fedewa reports no relevant financial disclosures.