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Locations and reasons for initial testing for hepatitis C infection--chronic hepatitis cohort study, United States,
Insights
Most hepatitis C virus (HCV) infections are initially diagnosed in doctor’s offices, often after symptoms appear. Improving physician-led testing strategies can help detect HCV infections earlier, reducing disease progression.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Chronic hepatitis C virus (HCV) infection is a significant cause of liver disease and death in the U.S.
- Many individuals with HCV remain unaware of their infection, hindering timely treatment and disease prevention.
- Current CDC guidelines recommend risk-based testing and a one-time screen for individuals born between 1945-1965.
Purpose of the Study:
- To investigate the settings and reasons for initial hepatitis C virus (HCV) testing among infected individuals.
- To identify opportunities for earlier detection of HCV infection.
- To inform strategies for improving HCV testing rates and outcomes.
Main Methods:
- Analysis of data from the Chronic Hepatitis Cohort Study (2006-2010).
- Survey responses from 4,689 patients with diagnosed HCV infection.
- Examination of reasons cited for initial HCV testing, including risk-based and clinical indications.
Main Results:
- The majority of initial HCV tests (60.4%) occurred in physician's offices.
- Risk-based indications accounted for 22.3% of initial tests.
- Clinical indications, such as abnormal liver tests or symptoms, were cited by 45.2% of patients, indicating diagnosis after disease progression.
Conclusions:
- Physician's offices are the primary setting for initial HCV testing.
- A significant proportion of HCV infections are detected only after patients develop symptoms or abnormal liver function.
- Enhanced implementation of recommended HCV testing strategies in clinical settings is crucial for early detection and improved patient outcomes.
Abstract:
Chronic hepatitis C virus (HCV) infection causes substantial morbidity and mortality in the United States. Testing and treatment of asymptomatic persons might avert progression to more advanced disease. In 1998, CDC published guidelines for HCV testing based on risk factors for infection; however, recent studies indicate that at least one half of all persons living with HCV infection in the United States are unaware of their infection status. To increase testing rates, in 2012 CDC recommended one-time testing of all persons born during 1945-1965. To better understand where and why persons with chronic HCV infection sought their initial testing, 2006-2010 data were analyzed from a survey conducted as part of the ongoing Chronic Hepatitis Cohort Study. Of 4,689 patients with HCV infection who responded to the survey, 60.4% reported that their initial HCV test occurred in a physician's office. CDC's risk-based indications (e.g., injection drug use and hemodialysis) were cited by 1,045 (22.3%) of the patients as reasons for testing, whereas clinical indications (e.g., abnormal liver function tests or liver-related symptoms such as jaundice) were cited by 2,121 (45.2%), suggesting that many HCV infections were identified only after the patient had become symptomatic. Promoting U. S. Preventive Services Task Force and CDC recommendations for testing and identifying strategies that help physicians implement HCV testing in their offices might help facilitate timely identification of HCV infection and reduce morbidity and mortality.
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