From 2013 to 2017, hepatitis C virus testing in the United States marginally increased among people born between 1966 and 1994 and 1945 and 1965, possibly as a result of better awareness of HCV in these population groups, researchers said.
WHO has set global targets to reduce HCV incidence by 90% and HCV-related mortality by 65% by 2030, which could prevent approximately 28,000 HCV-related deaths in the U.S., according to Eshan U. Patel, MPH, public health researcher at Johns Hopkins University School of Medicine, and colleagues.
“A principal barrier to these goals, however, is that HCV infection is often clinically silent and most persons living with HCV are underdiagnosed,” Patel and colleagues wrote in Clinical Infectious Diseases. “Reaching national targets will require diagnosing at least 70,000 to 110,000 cases each year until 2030. HCV testing strategies therefore need to be continuously monitored, and augmented, as needed.”
The CDC recommends HCV testing for all high-risk populations, as well as one-time HCV testing for all baby boomers — a high-risk group — independent of other risk factors. According to the authors, there is interest in extending the one-time HCV testing recommendation to adults born after 1965.
To determine who is being reached under current recommendations, researchers analyzed data from 2013 to 2017 from the National Health Interview Survey, which is conducted annually by the Nation Center for Health Statistics. As part of the survey, participants were asked if they ever had a blood test for HCV and were given response options of “yes,” “no,” “don’t know,” “refused to answer,” and “not ascertained.”
According to the study, 133,602 adults born between 1945 and 1994 completed the survey. Patel and colleagues reported a significant increase in HCV testing coverage among non-baby boomers and baby boomers, from 13.2% to 16.8% and 12.3% to 17.3% respectively. They hypothesized that the increase in non-baby boomer testing was due to better awareness of HCV infection related to the opioid epidemic. For baby boomers, they said this increase may be due to the uptake of one-time HCV testing recommendations and increasing awareness of direct-acting antivirals.
The survey also revealed that testing among baby boomers was significantly lower among women, people with less than a high school education and foreign-born individuals. Testing also varied depending on type of health insurance, with private, military and public health insurance having positive associations with HCV testing, they reported.
“As of 2017, the majority of the U.S. household population has not been tested for HCV infections. This study highlights sociodemographic disparities in HCV testing coverage, even in the baby boomer population for whom testing is universally recommended,” they concluded. “These data indicate geographic region and lack of adequate health insurance are systemic barriers to HCV testing. Disparities in HCV testing could potentially perpetuate disparities in awareness of HCV infection (and subsequently across the HCV care continuum).
“In addition to interventions to improve HCV screening in traditional health care settings, integrating HCV testing programs in nontraditional settings and implementing community-based programs may be key strategies to expand coverage of HCV testing.” – by Caitlyn Stulpin
Disclosure: The authors report no relevant financial disclosures.