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Hepatitis C testing practices and prevalence in a high-risk urban ambulatory care setting
W N Southern1, M-L Drainoni, B D Smith
1Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. wsouther@montefiore.org
Insights
Millions are infected with hepatitis C virus (HCV), often unknowingly. This study reveals risk factors for HCV testing and infection in an urban population, highlighting a high prevalence of 7.7%.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Approximately 3.2 million individuals in the U.S. have chronic hepatitis C virus (HCV) infection, with many unaware of their status.
- Effective screening strategies are crucial for identifying and managing HCV infections, particularly in high-risk populations.
- Understanding patient characteristics associated with HCV testing and positivity is essential for targeted public health interventions.
Purpose of the Study:
- To examine hepatitis C virus (HCV) testing practices within a large urban healthcare system.
- To identify patient demographics and clinical factors associated with HCV testing and anti-HCV positivity.
- To estimate the prevalence of HCV infection in a high-risk urban population.
Main Methods:
- A serial cross-sectional study (Hepatitis C Assessment and Testing Project - HepCAT) was conducted at Montefiore Medical Center.
- Electronic medical records of patients with clinic visits between January 1, 2008, and February 29, 2008, were analyzed.
- Demographic data, laboratory results, and ICD-9 codes were extracted to identify risk factors and estimate HCV prevalence.
Main Results:
- Of 9,579 subjects, 39.7% were tested for HCV, and 11.5% of those tested were positive.
- The estimated overall prevalence of HCV infection in the study population was 7.7%.
- Risk factors associated with testing and positivity included birth cohort (1945-1964), substance abuse, HIV infection, alcohol abuse, cirrhosis, end-stage renal disease, and elevated alanine transaminase.
Conclusions:
- A significant proportion of patients in this high-risk urban setting were tested for HCV, indicating a degree of screening success.
- The study identified key risk factors that can guide physicians in implementing risk-based screening strategies for HCV.
- Physician screening practices appear to be risk-based, contributing to the identification of HCV infection in this population.
Abstract:
Approximately 3.2 million persons are chronically infected with the hepatitis C virus (HCV) in the U.S.; most are not aware of their infection. Our objectives were to examine HCV testing practices to determine which patient characteristics are associated with HCV testing and positivity, and to estimate the prevalence of HCV infection in a high-risk urban population. The study subjects were all patients included in the baseline phase of the Hepatitis C Assessment and Testing Project (HepCAT), a serial cross-sectional study of HCV screening strategies. We examined all patients with a clinic visit to Montefiore Medical Center from 1/1/08 to 2/29/08. Demographic information, laboratory data and ICD-9 diagnostic codes from 3/1/97-2/29/08 were extracted from the electronic medical record. Risk factors for HCV were defined based on birth date, ICD-9 codes and laboratory data. The prevalence of HCV infection was estimated assuming that untested subjects would test positive at the same rate as tested subjects, based on risk-factors. Of 9579 subjects examined, 3803 (39.7%) had been tested for HCV and 438 (11.5%) were positive. The overall prevalence of HCV infection was estimated to be 7.7%. Risk factors associated with being tested and anti-HCV positivity included: born in the high-prevalence birth-cohort (1945-64), substance abuse, HIV infection, alcohol abuse, diagnosis of cirrhosis, end-stage renal disease, and alanine transaminase elevation. In a high-risk urban population, a significant proportion of patients were tested for HCV and the prevalence of HCV infection was high. Physicians appear to use a risk-based screening strategy to identify HCV infection.
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