In the Journals

Universal ED screening detects unrecognized HCV at UAB Hospital

Universal hepatitis C virus infection screening in the ED of University of Alabama at Birmingham Hospital successfully identified unrecognized infection in patients outside of the baby boomer population, according to results of a geographical analysis.

“Increasing awareness is the key. Only about half of those with HCV nationwide know they are infected. We have options for treating and curing HCV, but we have to identify the infection first,” James W. Galbraith, MD, associate professor in the department of emergency medicine, University of Alabama at Birmingham School of Medicine, said in a press release.

James W. Galbraith, MD

James W. Galbraith

In September 2013, UAB physicians implemented an HCV screening program that offered opt-out screening to all baby boomers and individuals with a history of injection drug use — the most at-risk populations — in UAB Hospital ED. The testing began as part of a CDC initiative to identify patients with HCV and then link them to care. In September 2015, UAB expanded the testing to include all patients who entered the ED.

To determine if the ED-based HCV screening had any impact, Galbraith and colleagues conducted a geospatial analysis of newly diagnosed HCV patients seen in the ED between September 2013 and February 2015.

During that time, 8,742 HCV tests were performed, of which 6,888 tests were performed on baby boomers and 64.7% of all Alabama’s zip codes were represented. The overall prevalence of HCV was 11.6%. However, when the program became universal, more individuals outside of the baby boomer population were identified as having HCV.

“We found an infection rate of 12% of white individuals born after 1965, Galbraith said. “The virus is most commonly transmitted by injectable drug use, so that population has become a key demographic to identify.”

Galbraith noted there is no national policy to conduct HCV screenings in ED and other secondary care settings. However, he believes the ED is a critical location for these types of programs, according to the release.

“Not only does the testing help link these patients to treatment for hepatitis, it also gives us an opportunity to reach out and provide therapy for addiction. We think we are making a huge difference in this population,” adding that HCV could potentially be eradicated in 20 years if universal ED HCV screening was implemented on a national level.

Michael S. Saag, MD, professor of medicine, Jim Straley Chair in AIDS Research and director of the Center for AIDS Research, UAB, and Co-Chief Medical Editor of HCV Next, also believes expanding testing could help eradicate HCV.

Michael S. Saag, MD

Michael S. Saag

“This study underscores the need for all of us to redouble our efforts to identify all people in the U.S. who are infected with HCV, link them to care and provide therapy to cure their infection,” Saag told Healio.com/hepatology. “We have the opportunity potentially to eradicate HCV, but we need to expand our testing beyond the baby boomers and include everyone.”

The researchers concluded: “These findings suggest that screening at a single hospital ED may have wide geographic reach and provide vital surveillance data to guide organized HCV prevention or treatment efforts that target high-risk communities.” – by Melinda Stevens

Disclosure: Galbraith reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Universal hepatitis C virus infection screening in the ED of University of Alabama at Birmingham Hospital successfully identified unrecognized infection in patients outside of the baby boomer population, according to results of a geographical analysis.

“Increasing awareness is the key. Only about half of those with HCV nationwide know they are infected. We have options for treating and curing HCV, but we have to identify the infection first,” James W. Galbraith, MD, associate professor in the department of emergency medicine, University of Alabama at Birmingham School of Medicine, said in a press release.

James W. Galbraith, MD

James W. Galbraith

In September 2013, UAB physicians implemented an HCV screening program that offered opt-out screening to all baby boomers and individuals with a history of injection drug use — the most at-risk populations — in UAB Hospital ED. The testing began as part of a CDC initiative to identify patients with HCV and then link them to care. In September 2015, UAB expanded the testing to include all patients who entered the ED.

To determine if the ED-based HCV screening had any impact, Galbraith and colleagues conducted a geospatial analysis of newly diagnosed HCV patients seen in the ED between September 2013 and February 2015.

During that time, 8,742 HCV tests were performed, of which 6,888 tests were performed on baby boomers and 64.7% of all Alabama’s zip codes were represented. The overall prevalence of HCV was 11.6%. However, when the program became universal, more individuals outside of the baby boomer population were identified as having HCV.

“We found an infection rate of 12% of white individuals born after 1965, Galbraith said. “The virus is most commonly transmitted by injectable drug use, so that population has become a key demographic to identify.”

Galbraith noted there is no national policy to conduct HCV screenings in ED and other secondary care settings. However, he believes the ED is a critical location for these types of programs, according to the release.

“Not only does the testing help link these patients to treatment for hepatitis, it also gives us an opportunity to reach out and provide therapy for addiction. We think we are making a huge difference in this population,” adding that HCV could potentially be eradicated in 20 years if universal ED HCV screening was implemented on a national level.

Michael S. Saag, MD, professor of medicine, Jim Straley Chair in AIDS Research and director of the Center for AIDS Research, UAB, and Co-Chief Medical Editor of HCV Next, also believes expanding testing could help eradicate HCV.

Michael S. Saag, MD

Michael S. Saag

“This study underscores the need for all of us to redouble our efforts to identify all people in the U.S. who are infected with HCV, link them to care and provide therapy to cure their infection,” Saag told Healio.com/hepatology. “We have the opportunity potentially to eradicate HCV, but we need to expand our testing beyond the baby boomers and include everyone.”

The researchers concluded: “These findings suggest that screening at a single hospital ED may have wide geographic reach and provide vital surveillance data to guide organized HCV prevention or treatment efforts that target high-risk communities.” – by Melinda Stevens

Disclosure: Galbraith reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.