A Birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks: a cross-sectional study.

William N Southern,Joseph Deluca,Bryce D Smith,Brianna Norton,Alain H Litwin,Mari-Lynn Drainoni,Meredith Steinman

doi:10.1186/s12879-015-1283-3

Abstract

BackgroundInternational guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945–1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy.MethodsWe used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project.ResultsCompared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5 % vs. 49.5 %, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0 % vs. 46.7 %, p = 0.002), or the composite any risk-associated factor (55.9 % vs. 79.0 %, p = 0.002).ConclusionsBirth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.

Highlights

International guidelines and U.S guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed
Previous U.S and many international guidelines recommend testing patients at risk for HCV infection including those with a history of injection drug use, recipients of transfusions or organ transplants, and those with elevated alanine aminotransferase (ALT) levels [7,8,9,10,11,12]
We hypothesized that patients identified as HCVAb + using a birth-cohort testing strategy would be less likely to have documented risk factors or medical indications as compared to patients identified as HCVAb + by traditional risk-based testing strategy

Summary

Introduction

International guidelines and U.S guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945–1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. It is possible that a birth-cohort-based testing strategy is more effective for identification of HCVinfected patients who have no known risk factors or medical indications for HCV testing. We hypothesized that patients identified as HCVAb + using a birth-cohort testing strategy would be less likely to have documented risk factors or medical indications as compared to patients identified as HCVAb + by traditional risk-based testing strategy

Methods

Results

Discussion

Conclusion