High-impact hepatitis C virus testing for injection drug users in an urban ED

We implemented the "High-Impact Testing for Injection Drug Users", or the "HIT IDU" initiative, an emergency physician (EP)-based hepatitis C virus (HCV) testing program. The objective of this study was to evaluate the outcomes of this clinical protocol.

This was a prospective observational pilot study. The HIT IDU initiative encouraged EPs to integrate targeted HCV testing into care, with an emphasis on screening all people who inject drugs (PWID). Physicians selected the primary indication for HCV testing from a drop-down menu integrated into the electronic ordering process. The primary outcome was the absolute number and overall proportion of EP-based HCV antibody positive tests, further stratified by the indication for testing.

Over the 3-month study period, 14,253 unique patients were evaluated, and EPs tested 155 patients for HCV (1.1%; 95% confidence interval [CI], 0.9%-1.2%), of which 40 (26%, 95% CI, 19%-33%) were HCV antibody positive. The proportion of HCV antibody positivity by testing indication was as follows: PWID 47% (34/73; 95% CI, 35%-59%), patient requested test 10% (4/40; 95% CI, 3%-24%), confirm patient report 67% (2/3; 95% CI, 9%-99%), liver disease of uncertain etiology 0% (0/3; 95% CI, 0%-71%), and other 0% (0/36; 95% CI, 0%-10%). There were 22 patients chronically infected, 19 had a follow-up appointment arranged, 3 attended their follow-up appointment, and 1 patient was treated at 1 year of follow-up.

Although the overall number of EP-based HCV tests performed was low, high rates of infection were identified, particularly among PWID. There were significant challenges with linkage to care.