Hepatitis C screening trends in a large integrated health system
Benjamin P Linas1, Haihong Hu2, Devra M Barter3
1HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, Mass; Department of Epidemiology, Boston University School of Public Health, Boston, Mass.
Insights
Hepatitis C virus (HCV) screening is increasing but remains incomplete in the US. Routine screening is recommended to improve detection rates, as targeted approaches are insufficient.
Area of Science:
- Hepatology and Infectious Diseases
- Public Health and Epidemiology
- Health Services Research
Background:
- Hepatitis C virus (HCV) infection screening rates in the US remain low, between 1% and 12%, despite the availability of new therapies.
- Current trends in HCV screening practices across healthcare systems are not well-documented.
Purpose of the Study:
- To investigate trends and patterns of HCV antibody screening within a large integrated healthcare system.
- To identify patient and provider factors associated with HCV screening and assess screening positivity rates.
Main Methods:
- Retrospective analysis of electronic health records from Kaiser Permanente Mid-Atlantic States (KPMAS) from January 1, 2003, to December 31, 2012.
- Inclusion of 444,594 patients to determine screening proportions, cumulative incidence, positivity rates, performing provider types, and patient-level predictors.
Main Results:
- Overall, 15.8% of the cohort was screened for HCV during the study period.
- Adult primary care and obstetrics/gynecology providers conducted 75.9% of screenings, with an overall positivity rate of 3.8%.
- Screening was higher in younger patients and those with documented illicit drug use history; patients with missing drug use history were least likely to be screened.
Conclusions:
- While HCV screening rates are increasing, they remain insufficient to control the epidemic.
- Targeting screening based on documented drug use history is limited due to incomplete records.
- Routine, systematic HCV screening is proposed as the most effective strategy to enhance screening coverage.
Background:
As new hepatitis C virus (HCV) therapies emerge, only 1%-12% of individuals are screened in the US for HCV infection. Presently, HCV screening trends are unknown.
Methods:
We utilized the Kaiser Permanente Mid-Atlantic States' (KPMAS) data repository to investigate HCV antibody screening between January 1, 2003 and December 31, 2012. We identified the proportion screened for HCV and 5-year cumulative incidence of screening, the screening positivity rate, the provider types performing HCV screening, patient-level factors associated with being screened, and trends in screening over time.
Results:
There were 444,594 patients who met the inclusion criteria. Overall, 15.8% of the cohort was ever screened for HCV. Adult primary care and obstetrics and gynecology providers performed 75.9% of all screening. The overall test positivity rate was 3.8%. Screening was more frequent in younger age groups (P <.0001) and those with a documented history of illicit drug use (P <.0001). Patients with missing drug use history (46.7%) were least likely to be screened (P <.0001). While the rate of HCV screening increased in the later years of the study among those enrolled in KPMAS 2009-2012, only 11.8% were screened by the end of follow-up.
Conclusion:
Screening for HCV is increasing but remains incomplete. Targeting screening to those with a history of injection drug will not likely expand screening, as nearly half of patients have no documented drug use history. Routine screening is likely the most effective approach to expand HCV screening.
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