Urban ED HCV screening programs should be expanded, researchers say

Patients diagnosed with hepatitis C infection in an ED setting can be treated and cured at similar rates as those diagnosed in ambulatory care settings, despite the challenges these patients may face, according to findings published in Clinical Infectious Diseases.

The findings prompted researchers to recommend expanding HCV screening programs in EDs.

“It may be reasonable to conjecture that patients screened in the ED for HCV would face significant patient-level and system-level barriers to treatment,” James W. Galbraith, MD, associate professor in the department of emergency medicine at the University of Alabama, Birmingham, and colleagues wrote. “Urban ED patients have been shown to have lower median incomes, less adequate insurance coverage and higher rates of substances use disorders, and homelessness when compared to patients in the ambulatory care setting.”

EDs are not as well connected to greater health systems, Galbraith noted, which would make getting patients access to subspecialty care more difficult.

“Despite these concerns, there may be tremendous public health benefit for HCV screening in the ED setting,” the researchers wrote.

Galbraith and colleagues performed a retrospective cohort study on two HCV screening programs in urban EDs, following patients who screened HCV antibody reactive from May 1, 2014, to Oct. 1, 2014. The researchers’ primary outcome was the absolute number and proportion of patients who completed various stages of the HCV continuum of care.

Of 3,704 patients estimated to have undiagnosed HCV infection, the screening programs identified 532 (14.4%) patients as HCV antibody reactive, the researchers reported. Four hundred thirty-five of those went through viral load testing (82%), and 301 (69%) were chronically infected. One hundred fifty-eight of chronically infected patients (52%) arranged follow-up appointments, with 97 of those (61%) attending their appointments. Twenty-four patients who attended their appointments (25%) began treatment, and 19 of those who began treatment (79%) achieved a sustained virologic response, Galbraith and colleagues wrote.

The researchers suggested that the drop-offs in the initial stages of the care continuum “may be the most amenable to innovations in ED processes and protocol modifications,” pointing out that patients who could not undergo viral load testing in the ED often took 100 days to complete testing.

“Emergency department patients have a high prevalence of undiagnosed HCV infection, and while there are challenges in linkage to care and treatment, our results demonstrate treatment outcomes that mirror those in other venues that perform HCV screening,” Galbraith and colleagues wrote. “Especially as EDs often act as safety net health care providers for patients without access to primary care, ED HCV screening programs ought to be expanded.” – by Andy Polhamus

Disclosure: Galbraith reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.