Emergency department testing is feasible but ineffective to eliminate hepatitis C in Denmark

Abstract

Background As direct-acting antiviral treatment for hepatitis C virus (HCV) is widely available in Denmark, the hindrance to achieving elimination lies in identifying infections. Effective identification relies on screening in high-risk populations. Here, we report the outcomes of a risk-based, point-of-care (POC) screening strategy in a Danish emergency department (ED). Methods During a three-month period, ED patients at Odense University Hospital were screened for risk factors and offered POC HCV-antibody (HCV-Ab) testing. Reactive results were followed up by confirmatory venepuncture testing. The main outcome measure was prevalence of HCV-antibodies. Secondary outcome measures were prevalence of risk factors and an evaluation of feasibility of ED screening. Results During study times, 1831 (55.7%) of 3288 presentations to the ED were eligible for screening. Six hundred and seventy-three (36.8%) were approached, of which 514 (28.1%) participated and 159 (8.7%) declined. Of 514 participants, 339 (66%) reported one or more risk factors, and 489 (95.1%) underwent HCV-Ab testing. Four (0.8%) had a reactive HCV-Ab test. No active infections of HCV were found. The risk factor of having injected drugs was present in all HCV-Ab positive patients. Compared to participants, patients who could not be approached had a lower prevalence of previously diagnosed hepatitis C- and risk-factor-associated diagnoses. Conclusions The risk factor of injecting drug use had the highest yield for HCV-Ab positivity. Additional risk factors did not contribute to case-finding. This screening strategy was feasible but ineffective. Further testing strategies will be necessary to identify the remaining hepatitis C patients in Denmark.