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Associations Between Patient Language Preference and Hepatitis C Screening: Results From the DETECT Hep C Emergency
Molly Thiessen1, Jason Haukoos2, Emily Hopkins1
1Department of Emergency Medicine, Denver Health, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Colorado Social Emergency Medicine Collaborative, Denver, CO.
Study Objective:
Hepatitis C virus (HCV) is the most common blood-borne infection in the United States, hence, emergency department (ED)-based HCV screening is effective for diagnosing HCV as an important step leading to referral for treatment. A patient's preferred language other than English (PLOE) may negatively affect overall care, although no prior research has evaluated the effect of language preference on HCV screening in EDs. Thus, the goal of this study was to estimate associations between language preference and HCV testing offer and acceptance as part of routine HCV screening in the ED.
Methods:
We performed a secondary analysis of data from the DETECT Hep C Screening Trial, a 3-center, pragmatic randomized clinical trial comparing effectiveness of targeted and nontargeted HCV screening in EDs. To estimate associations between PLOE (versus English) and HCV test offer and acceptance (primary outcomes) while adjusting for potential confounders, risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using multivariable modified Poisson regression. Secondary outcomes included HCV test completion and HCV test antibody and RNA test results.
Results:
A total of 147,498 patients were randomly assigned (median age: 41 years; interquartile range [IQR]: 29-57; 51.5% male, 42.3% Black, Non-Hispanic; 20.9% Hispanic; 32.2% White, Non-Hispanic; 10.3% PLOE). We observed significant heterogeneity in patient characteristics, outcomes, and estimates across sites. In the targeted HCV screening group, PLOE was associated with a lower probability of HCV test offer (RR: 0.75; 95% CI 0.70 to 0.79) and HCV test acceptance (RR: 0.69; 95% CI 0.60 to 0.79). In the nontargeted HCV screening group, PLOE was not associated with HCV test offer (RR: 1.00; 95% CI 0.97 to 1.04) but was associated with a lower probability of HCV test acceptance (RR: 0.82; 95% CI 0.76 to 0.89).
Conclusions:
Among ED patients with PLOE, those who underwent targeted HCV screening had a lower probability of HCV test offer and acceptance compared with those who preferred English. For those who underwent nontargeted HCV screening, there was no difference in HCV test offer but a lower probability of acceptance compared with those who preferred English. Nontargeted HCV screening may be preferred when attempting to optimize test completion among populations with PLOE, although understanding and optimizing barriers to screening among those with PLOE are needed.
