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. 2014 May;127(5):398-405.
doi: 10.1016/j.amjmed.2014.01.012. Epub 2014 Jan 28.

Hepatitis C screening trends in a large integrated health system

Benjamin P Linas  1 , Haihong Hu  2 , Devra M Barter  3 , Michael Horberg  2
Affiliations

Hepatitis C screening trends in a large integrated health system

Benjamin P Linas et al. Am J Med. 2014 May.

Abstract

Background: As new hepatitis C virus (HCV) therapies emerge, only 1%-12% of individuals are screened in the US for HCV infection. Presently, HCV screening trends are unknown.

Methods: We utilized the Kaiser Permanente Mid-Atlantic States' (KPMAS) data repository to investigate HCV antibody screening between January 1, 2003 and December 31, 2012. We identified the proportion screened for HCV and 5-year cumulative incidence of screening, the screening positivity rate, the provider types performing HCV screening, patient-level factors associated with being screened, and trends in screening over time.

Results: There were 444,594 patients who met the inclusion criteria. Overall, 15.8% of the cohort was ever screened for HCV. Adult primary care and obstetrics and gynecology providers performed 75.9% of all screening. The overall test positivity rate was 3.8%. Screening was more frequent in younger age groups (P <.0001) and those with a documented history of illicit drug use (P <.0001). Patients with missing drug use history (46.7%) were least likely to be screened (P <.0001). While the rate of HCV screening increased in the later years of the study among those enrolled in KPMAS 2009-2012, only 11.8% were screened by the end of follow-up.

Conclusion: Screening for HCV is increasing but remains incomplete. Targeting screening to those with a history of injection drug will not likely expand screening, as nearly half of patients have no documented drug use history. Routine screening is likely the most effective approach to expand HCV screening.

Keywords: Hepatitis C virus; Screening rates; Screening trends.

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Conflict of interest statement

The authors declare that they have no conflicts of interest. All authors had access to the data and a role in writing the manuscript.

Figures

Figure 1
Figure 1
A flow chart of the construction of the analysis cohort from the Kaiser Permanente Mid-Atlantic States Region Electronic Medical Record.
Figure 2
Figure 2
Cumulative incidence of receiving an HCV antibody test following enrollment in the Kaiser Permanente Mid-Atlantic States integrated healthcare plan. Results are presented for men (A) and women (B) and are stratified by year of birth.
Figure 2
Figure 2
Cumulative incidence of receiving an HCV antibody test following enrollment in the Kaiser Permanente Mid-Atlantic States integrated healthcare plan. Results are presented for men (A) and women (B) and are stratified by year of birth.
See this image and copyright information in PMC

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