Improving Hepatitis C Screening Rates in a Resident Clinic: A Quality Improvement Project

Abstract

Introduction: Hepatitis C virus (HCV) is the most common chronic blood-borne pathogen in the US. HCV is a viral liver disease that can result in cirrhosis, hepatocellular carcinoma, liver transplantation or death. CDC and USPSTF recommend HCV screening for all those born between 1945 and 1965- the baby boomer population. We designed a quality improvement project seeking to improve HCV screening rates in our ambulatory resident practice. Methods: We educated all residents and clinical staffs at ambulatory clinic by lectures, emails and weekly meetings about the importance of HCV screening in the baby boomers. All residents were asked to order a HCV Antibody profile as a screening test if the patient had never been tested. In case resident forgot to order it, then staff would order at the time of check out. If the test was positive, then patients were called and informed about the result and referred to hepatitis care clinic for further work up. Results: We screened 300 patients and 10 patients had a positive HCV screening test (3.3%). Only two patients had a positive viral load (20.0%). 5 out of 10 positive HCV positive patients had an intravenous drug abuse history (50.0%). No patient had undergone previous treatment for HCV infection. All 10 patients were referred to hepatitis care center for further monitoring. Conclusion: HCV screening is recommended in the baby boomer population (born between 1945-1965), history of illicit injection drug use or intranasal cocaine use and receipt of contaminated blood products or tissue. The initial screening test for chronic HCV infection in adults is an HCV antibody test. A reactive antibody test should be followed by a HCV RNA test. A nonreactive antibody test generally indicates the absence of chronic HCV infection. HCV screening can be increased by education and appropriate follow ups. Primary care clinics can successfully increase HCV screening in a relatively short time period. Incorporating a lecture about the new HCV screening guidelines to the ambulatory educational curriculum may be a more effective and sustainable strategy to increase HCV screening rates among residents.