Universal Screening for Hepatitis C Virus in the ED Using a Best Practice Advisory

Area of Science:

• Hepatology and Infectious Diseases
• Public Health and Preventive Medicine
• Emergency Medicine

Background:

• The United States Preventive Services Task Force (USPSTF) recommended universal hepatitis C virus (HCV) screening for adults in 2019.
• Emergency departments (EDs) are critical access points for identifying undiagnosed infections.
• Evaluating the impact of systematic screening protocols in the ED setting is essential for public health.

Purpose of the Study:

• To assess the effectiveness of an ED-based HCV screening program.
• To compare HCV screening practices and outcomes before and after the implementation of a best practice advisory (BPA).

Main Methods:

• Retrospective cohort analysis of two 11-month periods (pre- and post-BPA implementation).
• Screening for anti-HCV antibody (Ab) with follow-up HCV viral load (VL) testing for positive results.
• Primary outcomes included ED testing volume and seroprevalence of anti-HCV Ab and HCV VL.

Main Results:

• ED HCV testing volume increased dramatically post-BPA (mean 1361.9 tests/month vs. 19.8 tests/month).
• Anti-HCV Ab seroprevalence decreased post-BPA (9% vs. 23%), but the number of patients with detectable VLs (active infection) increased significantly (563 vs. 3).
• Reflex VL testing was implemented in 91% of positive anti-HCV Ab cases post-BPA.

Conclusions:

• A universal BPA-driven screening protocol effectively increases patient screening for HCV in the ED.
• This approach significantly enhances the identification of new HCV infections and active cases.
• ED-based screening programs utilizing BPA are vital for achieving widespread HCV diagnosis and control.