Study Highlights Lack of Hepatitis C Screening Despite Growing Prevalence

This article was originally published by HCPLive®. It has been lightly edited.

A common trend in community health centers across the United States is low hepatitis C virus (HCV) screening rates among patients who met guideline-recommended birth year criteria, according to findings from a recent study.¹

Of more than 20,000 patients born between 1945 and 1965 seen at a New York hospital between 2012 and 2019, 8.5% were screened for hepatitis C, 5.9% tested positive for the HCV antibody, and 3.0% had an active infection. These findings suggested a need for broader screening initiatives and more focused resource allocation to decrease the burden of HCV.

“New York is among a few states that have more than 100,000 individuals with HCV,” the authors wrote. “Concerningly, there is limited data on HCV exposure prevalence in local communities, raising concerns if effective screening strategies are in place.”

Hepatitis C | Image credit: jarun011 - stock.adobe.com

The US Preventive Service Task Force (USPSTF) and the CDC previously recommended screening for individuals born between 1945 and 1965 due to their high HCV burden. However, screening protocols have since changed to include any adult 18 years or older, accounting for HCV's growing prevalence across all age groups despite the availability of accurate diagnostic tests and medical treatment. Understanding HCV exposure prevalence is crucial for assessing the effectiveness of screening strategies and allocating additional resources to decrease the burden of HCV if necessary.²

Investigators sought to identify HCV screening rates, exposure prevalence, and specific demographics of a community in Long Island, New York.¹ To do so, they reviewed electronic medical records for all patients born between 1945 and 1965 seen in a 530-bed level 1 trauma center that has been screening patients within the previous screening age cohort for HCV since 2012. Investigators collected demographic data, history of intravenous drug use, and HIV coinfection status information for HCV-antibody-positive patients between January 1, 2012, and August 31, 2019.

Of 21,722 patients born between 1945 and 1965 seen in the hospital’s outpatient medical clinics, surgical clinics, emergency department, or for inpatient hospitalization or psychiatric encounters, 1858 (8.5%) individuals were screened for HCV. Among them, 109 (5.9%) tested positive for the HCV antibody and were subsequently tested for HCV RNA. This further testing showed 56 (3.0%) patients had active HCV infection with detectable RNA.

Of the 109 patients who tested positive, 77 (70.6%) were male, 32 (29.4%) were female, 58 (53.2%) were White, 37 (33.9%) were Black, and 6 (5.5%) were Asian. When looking at other factors related to HCV infection, investigators found 17 (15.6%) patients had a history of intravenous drug use, 4 (3.7%) had HIV coinfection, 5 (4.6%) had received previous treatment for HCV, and 2 (1.8%) had achieved sustained virologic response (SVR).

“This study highlights the need for broader screening initiatives and more focused resource allocation to decrease the burden of HCV in our community and likely that of other safety net institutions," the investigators concluded. "National guidelines provided by organizations such as the CDC and USPSTF need to be matched to the local population served, and public health programs should resource communities with a high HCV burden to most effectively diagnose and treat individuals actively infected with HCV before the development of chronic liver disease.”

References

1. Prasa J, Karim SS, Jacob B, et al. Hepatitis C prevalence on the rise but screening at safety net institutions lagging behind. International Journal of Hepatology. doi:10.1155/2023/3650746
2. US Centers for Disease Control and Prevention. Beyond baby boomers: Hepatitis C now heavily impacting multiple generations. NCHHSTP Newsroom. April 9, 2020. Accessed December 8, 2023. https://www.cdc.gov/nchhstp/newsroom/2020/hepatitis-c-impacting-multiple-generations-press-release.html