Nav: Home

Emergency departments can be an effective venue for Hepatitis C virus testing

July 23, 2018

Boston Medical Center has shown that testing for the Hepatitis C Virus (HCV) outside the typical high-risk population can be successfully implemented in an emergency department setting, resulting in more patients being screened, diagnosed and treated who might not have been otherwise. The new study, published in Academic Emergency Medicine, is the first report of a large scale emergency department program, which increased the monthly rate of HCV screening by more than 6,000 percent by testing regardless of patients' perceived risk for the disease.

In 2012, the Centers for Disease Control and Prevention endorsed guidance for routine one-time HCV screening for individuals born between 1945 and 1965, as well as the continued targeted testing for drug users and others at high risk for HCV infection. However, that guidance has had little impact on those born after 1965, and since 2011, the steady, significant increase in new HCV infections nationally is attributable to the opioid epidemic and associated injection drug use.

"Our findings indicate that if we had only tested the high risk birth cohort, there would have been 268 missed cases and 155 missed active infections," said Elissa Perkins, MD, MPH, the study's lead author and an emergency medicine physician at Boston Medical Center. "Physicians and patients should consider screening for HCV outside of the typical high-risk groups to ensure appropriate HCV diagnosis."

HCV is a condition that is easily transmissible by contact with blood or through sharing needles with an infected person. Over time, it can cause liver inflammation and lead to liver failure. There are effective treatments available, but many patients are unaware that they have the infection.

The researchers collected data from a three month period, between November 2016 and January 2017, and found that HCV tests were performed in BMC's emergency department on 3,808 patients, an average of 1,269 per month. That was a 6,950 percent increase from the 2015 to 2016 monthly average of 18 HCV screenings per month. Patients had to be at least 13 years old, were already undergoing blood testing for clinical purposes, and gave authorization for HCV antibody and reflex confirmatory RNA tests.

Thirteen percent (504 cases) of the initial HCV tests were positive, and of those, 97 percent (493) had a follow up RNA test performed. Active infections were confirmed positive for 292 cases for an overall HCV positivity rate of almost 8 percent. Of those with an active infection, 155 cases, or 4 percent of all individuals tested, fell outside of the Center for Disease Control and Prevention's birth cohort for increased risk for HCV.

Perkins and her team used a Best Practice Advisory to alert providers in the emergency department about the program and generate order labels. Information technology allowed them to build documentation of verbal informed consent into patients' electronic medical records and make the HCV screening streamlined and efficient for the emergency department staff.

The study also attempted to link patients with active infections to follow up care; appointments were scheduled for 102 patients (approximately 35 percent), and ultimately, 66 patients made a care visit (22 percent of all active infection patients).

"Those 66 patients that were connected to care through our program demonstrate the importance of increasing screening rates for HCV infection," said Perkins.
Funding for the testing program was provided by a grant from Gilead Science, Inc.'s FOCUS Program, the Providence/Boston Center for AIDS Research, and by the Center for Health Economics.

Boston Medical Center

Related Hepatitis Articles:

Hepatitis C increasing among pregnant women
Hepatitis C infections among pregnant women nearly doubled from 2009-2014, likely a consequence of the country's increasing opioid epidemic that is disproportionately affecting rural areas of states including Tennessee and West Virginia.
WHO's Global Hepatitis Report sets baseline to eliminate viral hepatitis by 2030
The World Hepatitis Alliance today welcomes the publication of the first-ever Global Hepatitis Report by the World Health Organization (WHO), which includes new data on the prevalence and global burden of viral hepatitis.
Elimination of viral hepatitis by 2030: What's needed and how do we get there?
This first European Action Plan provides an important driver to aid countries in their fight against viral hepatitis, to which ECDC had the opportunity to contribute directly.
Discovery of new Hepatitis C virus mechanism
Researchers at Osaka University, Japan uncovered the mechanisms that suppress the propagation of the hepatitis C virus with the potential of improving pathological liver conditions.
Is Europe ready to eliminate viral hepatitis?
Currently, Europe records around 57,000 newly diagnosed acute and chronic cases of hepatitis B and C each year.
Why baby boomers need a hepatitis C screening
Hepatitis C affects a disproportionate amount of older Americans, born between 1945 and 1965.
Counterattack of the hepatitis B virus
The hepatitis B virus (HBV) infects liver cells. Drugs are available to treat HBV, but they rarely cure the infection, and so the virus typically returns after the treatment ends.
Hepatitis C tied to increased risk of Parkinson's
The hepatitis C virus may be associated with an increased risk of developing Parkinson's disease, according to a study published in the Dec.
The hepatitis A virus is of animal origin
The hepatitis A virus can trigger acute liver inflammation which generally has a mild course in small children but which can become dangerous in adults.
Modeling the helicase to understand hepatitis C
NS3 is an enzyme specific to the hepatitis C virus.

Related Hepatitis Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...