Results of a Rapid Hepatitis C Virus Screening and Diagnostic Testing Program in an Urban Emergency Department
STUDY OBJECTIVE:
We
describe the results of an emergency department (ED) hepatitis C virus testing
program that integrated birth cohort screening and screening of patients with a
history of injection drug use, as well as physician diagnostic testing,
according to national guidelines.
METHODS:
We
conducted a retrospective cohort study using data collected as part of clinical
care. The primary outcome was the hepatitis C virus prevalence among tested
patients. We evaluated factors associated with testing positive with logistic
regression.
RESULTS:
Of the
26,639 unique adults aged 18 years or older and presenting to the ED during the
6-month study, 2,581 (9.7%) completed hepatitis C virus screening (2,028) or
diagnostic testing (553), of whom 267 were antibody positive (10.3%
prevalence). Factors associated with testing positive for hepatitis C virus
included injection drug use (38.4% prevalence; odds ratio [OR] 10.8; 95%
confidence interval [CI] 7.5 to 15.5), homeless(25.5% prevalence; OR 3.1; 95% CI 1.5 to
6.8), diagnostic testing (14.8% prevalence; OR 2.6; 95% CI 1.7 to 3.9), birth
cohort (13.7% prevalence; OR 3.6; 95% CI 2.4 to 5.3), and male sex (12.4%
prevalence; OR 1.4; 95% CI 1.0 to 2.0). Of the 267 patients testing positive
for hepatitis C virus antibody, 137 (51%) had documentation of result
disclosure and 180 (67%) had confirmatory ribonucleic acid testing performed,
of whom 126 (70%) had a positive result. Follow-up appointments at the
hepatitis C virus clinic were arranged for 57 of the 126 (45%) patients with confirmed
positive results, of which 30 attended.
CONCLUSION:
This
ED screening and diagnostic testing program found a high prevalence of
hepatitis C virus antibody positivity across all groups. 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.
Below: Nurse triage template; HIV and hepatitis C virus screening questions
- 1Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA. Electronic address: dwhite@alamedahealthsystem.org.
- 2Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
- Ann Emerg Med. 2016 Jan;67(1):119-28. doi: 10.1016/j.annemergmed.2015.06.023. Epub 2015 Aug 4.
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