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Related Experiment Video

Updated: Sep 29, 2025

A Protocol for Analyzing Hepatitis C Virus Replication
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Hepatitis C Virus Reflex Testing Protocol in an Emergency Department.

Jacob J Manteuffel1, Madison S Lee1, Rebecca M Bussa1

  • 1Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan.

The Western Journal of Emergency Medicine
|March 18, 2022
PubMed
Summary

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Implementing hepatitis C virus (HCV) reflex testing in emergency departments significantly increased HCV viral RNA (vRNA) testing completion for at-risk patients. However, this did not lead to a statistically significant rise in linkage to care.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Hepatitis C virus (HCV) screening and linkage to care are critical for managing the disease.
  • Urban emergency departments (EDs) serve at-risk populations requiring effective screening protocols.
  • Evaluating new testing strategies like reflex testing is essential for improving patient outcomes.

Purpose of the Study:

  • To measure the impact of an HCV viral RNA (vRNA) reflex testing protocol on HCV screening and linkage-to-care rates in an urban ED.
  • To determine if reflex testing increases HCV testing rates among at-risk patients.
  • To assess the effect of reflex testing on connecting HCV antibody-positive patients to care.

Main Methods:

  • An automated, EHR-based HCV screening protocol was implemented in the ED for at-risk patients.

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  • An HCV vRNA reflex testing protocol was introduced for all positive HCV antibody (Ab) tests.
  • Completion rates of HCV vRNA testing and linkage-to-care rates were compared before and after reflex testing implementation.

    • Main Results:

    • HCV vRNA testing completion increased significantly after implementing reflex testing (84% vs. 55%, OR 4.2, P < 0.001).
    • Linkage to care rates showed a non-significant increase (14.2% with reflex testing vs. 10.6% without, OR 1.4, P = 0.13).
    • The reflex testing protocol demonstrated a substantial improvement in diagnostic test completion.

    Conclusions:

    • Implementing HCV vRNA reflex testing in ED screening programs enhances diagnostic test completion for HCV Ab-positive patients.
    • HCV vRNA reflex testing did not significantly improve linkage-to-care rates in this study.
    • Further research is needed to optimize linkage to care following reflex testing initiatives.