Hepatitis C Virus Testing Rate Research Articles

Prevalence of Human Immunodeficiency Virus, Hepatitis C Virus, and Hepatitis B Virus Among Homeless and Nonhomeless United States Veterans.

Veterans are disproportionately affected by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Homeless veterans are at particularly high risk for HIV, HCV, and HBV due to a variety of overlapping risk factors, including high rates of mental health disorders and substance use disorders. The prevalence of HIV, HCV, and HBV among homeless veterans nationally is currently unknown. This study describes national testing rates and prevalence of HIV, HCV, and HBV among homeless veterans. Using data from the Department of Veterans Affairs (VA) Corporate Warehouse Data from 2015, we evaluated HIV, HCV, and HBV laboratory testing and infection confirmation rates and diagnoses on the Problem List for nonhomeless veterans and for veterans utilizing homeless services in 2015. Among 242740 homeless veterans in VA care in 2015, HIV, HCV, and HBV testing occurred in 63.8% (n = 154812), 78.1% (n = 189508), and 52.8% (n = 128262), respectively. The HIV population prevalence was 1.52% (3684/242740) among homeless veterans, compared with 0.44% (23797/5424685) among nonhomeless veterans. The HCV population prevalence among homeless veterans was 12.1% (29311/242740), compared with 2.7% (148079/5424685) among nonhomeless veterans, while the HBV population prevalence was 0.99% (2395/242740) for homeless veterans and 0.40% (21611/5424685) among nonhomeless veterans. To our knowledge this work represents the most comprehensive tested prevalence and population prevalence estimates of HIV, HCV, and HBV among homeless veterans nationally. The data demonstrate high prevalence of HIV, HCV, and HBV among homeless veterans, and reinforce the need for integrated healthcare services along with homeless programming.

Interventions to optimise the care continuum for chronic viral hepatitis: a systematic review and meta-analyses

Advances in therapy for hepatitis B virus (HBV) and hepatitis C virus (HCV) have ushered in a new era in chronic hepatitis treatment. To maximise the effectiveness of these medicines, individuals must be engaged and retained in care. We analysed operational interventions to enhance chronic viral hepatitis testing, linkage to care, treatment uptake, adherence, and viral suppression or cure. We did a systematic review of operational interventions, and did meta-analyses for sufficiently comparable data. We searched PubMed, Embase, WHO library, International Clinical Trials Registry Platform, PsycINFO, and CINAHL for randomised controlled trials and controlled non-randomised studies that examined operational interventions along the chronic viral hepatitis care continuum, published in English up to Dec 31, 2014. We included non-pharmaceutical intervention studies with primary or secondary outcomes of testing, linkage to care, treatment uptake, treatment adherence, treatment completion, treatment outcome, or viral endpoints. We excluded dissertations and studies of children only. Data were extracted by two independent reviewers, with disagreements resolved by a third reviewer. Studies were assessed for bias. Data from similar interventions were pooled and quality of evidence was assessed using GRADE. This study was registered in PROSPERO (42014015094). We identified 7583 unduplicated studies, and included 56 studies that reported outcomes along the care continuum (41 for HCV and 18 for HBV). All studies except one were from high-income countries. Lay health worker HBV test promotion interventions increased HBV testing rates (relative risk [RR] 2·68, 95% CI 1·82-3·93). Clinician reminders to prompt HCV testing during clinical visits increased HCV testing rates (3·70, 1·81-7·57). Nurse-led educational interventions improved HCV treatment completion (1·14, 1·05-1·23) and cure (odds ratio [OR] 1·93, 95% CI 1·44-2·59). Coordinated mental health, substance misuse, and hepatitis treatment services increased HCV treatment uptake (OR 3·03, 1·24-7·37), adherence (RR 1·22, 1·05-1·41), and cure (RR 1·21, 1·07-1·38) compared with usual care. Several simple, inexpensive operational interventions can substantially improve engagement and retention along the chronic viral hepatitis care continuum. Further operational research to inform scale-up of hepatitis services is needed in low-income and middle-income countries. World Health Organization and US Fulbright Program.

Comparison of Current US Risk Strategy to Screen for Hepatitis C Virus With a Hypothetical Targeted Birth Cohort Strategy

We compared the theoretical performance of a 1-time, birth cohort strategy with the currently recommended risk strategy for screening for hepatitis C virus (HCV) infection, which is undetected in an estimated 75% of 4 million affected people in the United States. We applied current American Association for the Study of Liver Disease risk screening guidelines and a targeted birth cohort strategy to National Health and Nutrition Examination Survey data from 2003 to 2006 to estimate their performance in identifying HCV cases. Risk guidelines would recommend testing 25% of the US population aged 20 years or older and, if fully implemented, identify 82% of the projected HCV-exposed population. A targeted birth cohort (1946-1964) strategy would test 45% of the same population and identify 76% of the projected HCV population. In this ideal-world simulation, birth year and risk screening had similar theoretical performances for predicting HCV infection. However, actual implementation of risk screening has not achieved its theoretical performance, and birth cohort screening might increase HCV testing rates.

1094 THE PREVALENCE AND EXPOSURE RISK OF HEPATITIS C AND HIV INFECTION IN UROLOGICAL PROCEDURES

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20121094 THE PREVALENCE AND EXPOSURE RISK OF HEPATITIS C AND HIV INFECTION IN UROLOGICAL PROCEDURES Justin M. Watson, Adityanant Jain, Edgardo Reyes-Aponte, David Rimland, Jea Young Min, Michael Goodman, Chad W.M. Ritenour, and Muta M. Issa Justin M. WatsonJustin M. Watson Atlanta, GA More articles by this author , Adityanant JainAdityanant Jain Atlanta, GA More articles by this author , Edgardo Reyes-AponteEdgardo Reyes-Aponte Atlanta, GA More articles by this author , David RimlandDavid Rimland Atlanta, GA More articles by this author , Jea Young MinJea Young Min Atlanta, GA More articles by this author , Michael GoodmanMichael Goodman Atlanta, GA More articles by this author , Chad W.M. RitenourChad W.M. Ritenour Atlanta, GA More articles by this author , and Muta M. IssaMuta M. Issa Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infections with Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV) affect 3.2 million and 1.1 million Americans, respectively. A significant number of these infections are subclinical and undiagnosed. The purpose of this study is to determine the prevalence of these two infections in US Veterans undergoing urological procedures, and the related risk of exposure to the surgical team. METHODS All patients undergoing urological procedures over a 12-month period were offered routine screening for HCV & HIV. HVC test was a Vitros anti-HCV IgG antibody test. PCR was used to confirm true positives. HIV test was a Vitros Anti-HIV 1+2 Assay. Test results, demographic and clinical data were collected from all patients and analyzed. RESULTS A total of 1,907 diagnostic and therapeutic urological procedures were performed on 1,282 patients during the twelve-month study period. Of the 1,282 patients offered screening, 80.2% (n=1,028) consented for HCV testing and 80.3% (n=1,030) consented for HIV testing. The prevalence of HCV, both new and known, was 9.3% (96/1,028), which is 7 times the reported prevalence (∼1.3%) in the general population. This rate is significantly higher than the 2010 overall HCV testing rate of 7.1% (712/10,054) among Veterans at the AVAMC (p=0.003). The prevalence of HIV, both new and known, was 2.6% (27/1,030), which is almost 10 times the reported prevalence (∼0.28%) in the general population. This rate is significantly higher than the 2010 overall HIV testing rate of 0.46% (70/15,348) at the AVAMC (p<0.001). An elevated serum ALT level was present in 17.6% (225/1282) in the overall study population. Among patients with an elevated ALT, 37.8% were infected with HCV. CONCLUSIONS HCV and HIV infections are 7 and 10 times more prevalent in veterans compared to the general population, respectively. Urologists are at a risk of exposure to HCV one in every 10 procedures, and to HIV one in every 40 procedures. Routine screening for HVC and HIV should be considered in all patients undergoing urological procedures to establish early diagnosis and treatment, and to heighten awareness and secure precaution measures. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e444 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin M. Watson Atlanta, GA More articles by this author Adityanant Jain Atlanta, GA More articles by this author Edgardo Reyes-Aponte Atlanta, GA More articles by this author David Rimland Atlanta, GA More articles by this author Jea Young Min Atlanta, GA More articles by this author Michael Goodman Atlanta, GA More articles by this author Chad W.M. Ritenour Atlanta, GA More articles by this author Muta M. Issa Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Primary care-based interventions are associated with increases in hepatitis C virus testing for patients at risk

BackgroundAn estimated 3.2 million persons are chronically infected with the hepatitis C virus (HCV) in the U.S. Effective treatment is available, but approximately 50% of patients are not aware that they are infected. Optimal testing strategies have not been described. MethodsThe Hepatitis C Assessment and Testing Project (HepCAT) was a serial cross-sectional evaluation of two community-based interventions designed to increase HCV testing in urban primary care clinics in comparison with a baseline period. The first intervention (risk-based screener) prompted physicians to order HCV tests based on the presence of HCV-related risks. The second intervention (birth cohort) prompted physicians to order HCV tests on all patients born within a high-prevalence birth cohort (1945–1964). The study was conducted at three primary care clinics in the Bronx, New York. ResultsBoth interventions were associated with an increased proportion of patients tested for HCV from 6.0% at baseline to 13.1% during the risk-based screener period (P<0.001) and 9.9% during the birth cohort period (P<0.001). ConclusionsTwo simple clinical reminder interventions were associated with significantly increased HCV testing rates. Our findings suggest that HCV screening programs, using either a risk-based or birth cohort strategy, should be adopted in primary care settings so that HCV-infected patients may benefit from antiviral treatment.

Examining hepatitis c virus testing practices in primary care clinics

Prior studies found that hepatitis C virus (HCV) risk assessment and testing in primary care clinics were suboptimal. We aimed to determine the actual HCV testing rate among patients with HCV risk factors and to identify variables predictive of testing. In order to do so, we performed a prospective cohort study among patients seen in four urban primary care clinics. At the initial visit, patients were given a questionnaire that listed HCV risk factors and they were instructed to check 'yes' or 'no' if they did or did not have a risk factor, respectively. Patients then handed this questionnaire to their physician during their initial visit. Among those who acknowledged having a HCV risk factor via the questionnaire, we determined the subsequent HCV testing rate and calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) to identify variables predictive of testing. Of the 578 individuals who acknowledged having a HCV risk factor via the questionnaire, only 8% (46/578) were tested for HCV within 2 months of their initial visit. Among those tested, 11% (5/46) had a positive HCV antibody test result. The only variable predictive of HCV testing after adjusting for confounders was having a specific HCV risk factor identified and documented in the chart by physicians [16% (26/159) vs 5% (20/419); aOR 4.5, 95% CI 2.1-9.5]. In summary, 92% of patients with a HCV risk factor were not tested for HCV in the primary care setting, and efforts to improve such rates are clearly warranted.