Results of a Rapid Hepatitis C Virus Screening and Diagnostic Testing Program in an Urban Emergency Department - 19/12/15

Doi : 10.1016/j.annemergmed.2015.06.023

Douglas A.E. White, MD ^⁎ , Erik S. Anderson, MD, Sarah K. Pfeil, BS, Tarak K. Trivedi, MD, Harrison J. Alter, MD, MS
Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA

^∗Corresponding Author.

Abstract

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.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design

Setting

Selection of Participants

Data Collection and Processing

Outcome Measures

Primary Data Analysis

Results

Limitations

Discussion

	Please see page 120 for the Editor’s Capsule Summary of this article.
	Supervising editor: Gregory J. Moran, MD
	Author contributions: DAEW conceived the study and obtained research funding. DAEW, ESA, SKP, and HJA designed the study. DAEW and SKP supervised study administration. ESA and SKP managed the data. TKT and HJA provided statistical advice and analyzed the data. DAEW drafted the article, and all authors contributed substantially to its revision. DAEW takes responsibility for the paper as a whole.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. White and Ms. Pfeil report grants from Gilead Sciences during the conduct of this study.
	Gilead Sciences had no role in study design, results interpretation, or article preparation.
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