Text Messages Can Improve Hepatitis C Screening in Primary Care Settings

Abstract

Introduction: The U.S. Centers for Disease Control and Prevention (CDC) and American Association for the Study of Liver Diseases recommend that all adults born between 1945 and 1965 and adults with Hepatitis C virus (HCV) risk factors receive a screening test for HCV. Yet screening rates remain low. The CDC estimates that of 3 million persons living with HCV, up to 85% are unaware of their status. A recent survey found that 82% of primary care physicians (PCPs) lack confidence with screening guidelines. Encouraging patients to ask their PCPs for the HCV test may be a novel method to overcome this barrier and improve HCV screening rates in primary care. Text messaging is a ubiquitous platform that may educate patients about the need for HCV screening and could prompt patients to discuss screening with PCPs. Research has found patients would be comfortable receiving text messages encouraging HCV testing. Methods: We conducted a pilot study to investigate whether a patient-facing text message campaign could promote HCV screening. Patients from a primary care clinic were recruited to receive an HCV-related text message or general health text message (e.g., control message) one hour prior to a scheduled PCP appointment. Each text message prompted discussion of message content (HCV or general health topic) with their PCP that day. A retrospective chart review was performed to determine if HCV tests were ordered on the day the text message was sent. The baseline screening HCV prevalence for the clinic was determined by reviewing HCV test orders of non-enrolled patients. Standard descriptive statistics were used for data analysis. Results: Of 42 participants who attended their appointment, 29 received the HCV message and 13 received the control message. Eleven participants (37.9%) who received the HCV message had an HCV test ordered, and three (23.1%) who received the control message had the test ordered. The baseline HCV screening rate among 124 non-enrolled patients was 21.0%. Patients who received the HCV message were 1.88 times more likely than the baseline clinic population to be HCV tested. Conclusion: In this small pilot study, HCV testing nearly doubled for those receiving the HCV text message compared to those not enrolled in the study. This suggests that a text message campaign that has a meaningful message, prompts discussion of HCV with the physician, and is timely may improve HCV screening in primary care. Further research in a larger cohort is needed to confirm these results.