A Birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks

A cross-sectional study

William N. Southern, Brianna L. Norton, Meredith Steinman, Joseph P. DeLuca, Mari Lynn Drainoni, Bryce D. Smith, Alain H. Litwin

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. Methods: We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project. Results: Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5 % vs. 49.5 %, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0 % vs. 46.7 %, p = 0.002), or the composite any risk-associated factor (55.9 % vs. 79.0 %, p = 0.002). Conclusions: Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.

Original languageEnglish (US)
JournalBMC Infectious Diseases
DOIs
StateAccepted/In press - Dec 1 2015

Fingerprint

Hepatitis Viruses
Virus Diseases
Cross-Sectional Studies
Hepacivirus
Parturition
Hepatitis C Antibodies
Guidelines
Guideline Adherence
Electronic Health Records
Standard of Care
Hepatitis C
Risk-Taking
Alanine Transaminase
Substance-Related Disorders
Demography

Keywords

  • Hepatitis C virus
  • Risk assessment
  • Screening
  • Testing strategies

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

@article{8ff5c6a797ce40cebcc5d7f748c1fa56,
title = "A Birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks: A cross-sectional study",
abstract = "Background: International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. Methods: We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project. Results: Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5 {\%} vs. 49.5 {\%}, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0 {\%} vs. 46.7 {\%}, p = 0.002), or the composite any risk-associated factor (55.9 {\%} vs. 79.0 {\%}, p = 0.002). Conclusions: Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.",
keywords = "Hepatitis C virus, Risk assessment, Screening, Testing strategies",
author = "Southern, {William N.} and Norton, {Brianna L.} and Meredith Steinman and DeLuca, {Joseph P.} and Drainoni, {Mari Lynn} and Smith, {Bryce D.} and Litwin, {Alain H.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1186/s12879-015-1283-3",
language = "English (US)",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",

}

TY - JOUR

T1 - A Birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks

T2 - A cross-sectional study

AU - Southern, William N.

AU - Norton, Brianna L.

AU - Steinman, Meredith

AU - DeLuca, Joseph P.

AU - Drainoni, Mari Lynn

AU - Smith, Bryce D.

AU - Litwin, Alain H.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background: International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. Methods: We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project. Results: Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5 % vs. 49.5 %, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0 % vs. 46.7 %, p = 0.002), or the composite any risk-associated factor (55.9 % vs. 79.0 %, p = 0.002). Conclusions: Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.

AB - Background: International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. Methods: We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project. Results: Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5 % vs. 49.5 %, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0 % vs. 46.7 %, p = 0.002), or the composite any risk-associated factor (55.9 % vs. 79.0 %, p = 0.002). Conclusions: Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.

KW - Hepatitis C virus

KW - Risk assessment

KW - Screening

KW - Testing strategies

UR - http://www.scopus.com/inward/record.url?scp=84949255808&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84949255808&partnerID=8YFLogxK

U2 - 10.1186/s12879-015-1283-3

DO - 10.1186/s12879-015-1283-3

M3 - Article

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

ER -