Why Hospitals Screen Admitted Adult Patients for Hepatitis C
Hospitals screen admitted adult patients for hepatitis C because the U.S. Preventive Services Task Force (USPSTF) recommends one-time universal screening for all adults aged 18-79 years due to substantial net benefit in reducing mortality and morbidity from HCV-related liver disease. 1
Rationale for Universal HCV Screening
The USPSTF updated its recommendations in 2020 from risk-based and birth cohort screening to universal screening for all adults aged 18-79 years, based on evidence that this approach identifies more infected individuals who can benefit from highly effective treatment 1
There is convincing evidence that newer direct-acting antiviral (DAA) regimens result in sustained virologic response (SVR) in >95% of adults, which is associated with decreased risk of all-cause mortality, liver disease mortality, cirrhosis, and hepatocellular carcinoma 1
Many people with chronic HCV infection are unaware of their condition, and risk-based screening may miss a substantial proportion of infected individuals due to lack of patient disclosure or knowledge about prior risk status 1
Benefits of Hospital-Based HCV Screening
Hospital admission provides a unique opportunity to screen patients who might otherwise not access preventive healthcare services 2
Recent research shows that hospital-based universal screening can identify patients with positive viral load who fall outside the age ranges specified in previous screening recommendations 2
Implementation of HCV care pathways in healthcare settings, including automated screening alerts and reflex laboratory orders for positive antibody results, has been shown to increase screening rates, confirmation testing, and diagnosis communication to patients 3
Screening Process and Implementation
Screening involves testing for anti-HCV antibody followed by polymerase chain reaction (PCR) testing for viremia to confirm chronic HCV infection 1, 4
The USPSTF recommends that screening should be voluntary and undertaken only with the patient's knowledge and understanding that HCV testing is planned 1
Patients should be informed about HCV infection, how it can (and cannot) be acquired, the meaning of positive and negative test results, and the benefits and harms of treatment before screening 1
Most adults need to be screened only once, while persons with continued risk for HCV infection (e.g., people who inject drugs) should be screened periodically 1
Clinical Significance and Treatment Benefits
Early detection and treatment of HCV can prevent progression to cirrhosis, liver failure, and hepatocellular carcinoma 1, 5
Current all-oral direct-acting antiviral regimens without interferon are the standard treatment for chronic HCV infection, with shorter treatment duration (8-12 weeks) and lower rates of adverse effects than older therapies 1
Without treatment, approximately 20% of patients with chronic hepatitis C develop cirrhosis over a 10-year period, and between 1-4% of those with cirrhosis develop hepatocellular carcinoma each year 5
Implementation Challenges
Despite recommendations, national HCV screening rates in community health centers and from the National Health Interview Study were only 8.3% and 17.3%, respectively 1
Simple interventions like electronic health record prompts and educational materials can significantly increase screening rates, but more durable solutions are needed to maintain screening coverage 6
Implementation of successful screening may require addressing various barriers to screening and treatment in diverse populations 1