Primary care-based interventions are associated with increases in hepatitis C virus testing for patients at risk

• Published in: Digestive and liver disease 2012-06, Vol.44 (6), p.497-503
• Main Authors: Litwin, Alain H, Smith, Bryce D, Drainoni, Mari-Lynn, McKee, Diane, Gifford, Allen L, Koppelman, Elisa, Christiansen, Cindy L, Weinbaum, Cindy M, Southern, William N
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Aged; Analysis of Variance; Chi-Square Distribution; Chronic hepatitis C; Cross-Sectional Studies; European Continental Ancestry Group - statistics & numerical data; Female; Gastroenterology and Hepatology; HCV; Hepacivirus; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - virology; Hispanic Americans - statistics & numerical data; Humans; Insurance, Health - statistics & numerical data; Male; Mass Screening - statistics & numerical data; Middle Aged; New York City; Primary care; Primary Health Care - statistics & numerical data; Program Evaluation; Public health; Reminder Systems; Risk Factors; Screening; Urban Health Services - statistics & numerical data
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2011.12.014

Abstract Background An estimated 3.2 million persons are chronically infected with the hepatitis C virus (HCV) in the U.S. Effective treatment is available, but approximately 50% of patients are not aware that they are infected. Optimal testing strategies have not been described. Methods The Hepatitis C Assessment and Testing Project (HepCAT) was a serial cross-sectional evaluation of two community-based interventions designed to increase HCV testing in urban primary care clinics in comparison with a baseline period. The first intervention (risk-based screener) prompted physicians to order HCV tests based on the presence of HCV-related risks. The second intervention (birth cohort) prompted physicians to order HCV tests on all patients born within a high-prevalence birth cohort (1945–1964). The study was conducted at three primary care clinics in the Bronx, New York. Results Both interventions were associated with an increased proportion of patients tested for HCV from 6.0% at baseline to 13.1% during the risk-based screener period ( P < 0.001) and 9.9% during the birth cohort period ( P < 0.001). Conclusions Two simple clinical reminder interventions were associated with significantly increased HCV testing rates. Our findings suggest that HCV screening programs, using either a risk-based or birth cohort strategy, should be adopted in primary care settings so that HCV-infected patients may benefit from antiviral treatment.