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Abstract Details
Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department
Galbraith JW1, Franco RA, Donnelly JP, Rodgers JB, Morgan JM, Viles AF, Overton ET, Saag MS, Wang HE. Hepatology. 2014 Sep 1. doi: 10.1002/hep.27410. [Epub ahead of print]
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1Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama.
Abstract
The Centers for Disease Control and Prevention and United States Preventive Services Task Force have highlighted public screening as an essential strategy for increasing hepatitis C virus (HCV) detection in persons born between 1945 and 1965 ("baby boomers"). As prior HCV screening efforts have not targeted Emergency Department (ED) baby boomer patients, we describe early experience with integrated opt-out HCV antibody screening of medically stable "baby boomers" presenting to an urban academic ED. We performed HCV antibody testing 24 hours per day and confirmed positive test results using PCR. The primary outcome was prevalence of unrecognized HCV infection. Among 2,325 unique HCV-unaware baby boomers, 289 (12.7%) opted-out of HCV screening. We performed HCV-antibody tests on 1,529 individuals, of which 170 (11.1%) were reactive. Among antibody reactive cases, follow-up PCR was performed on 150 (88.2%), of which 102 (68.0%) were confirmed RNA-positive. HCV antibody reactivity was more likely in males compared to females (14.7% vs. 7.4%, p<0.001), African Americans compared to whites (13.3% vs. 8.8%, p=0.010), and underinsured/ uninsured patients compared to insured patients (16.8%/ 16.9% vs. 5.0%, p=0.001). Linkage-to-care service activities were recorded for 100 of the 102 confirmed cases. Overall, 54 (54%) RNA-positive individuals were successfully contacted by phone within five call back attempts. We confirmed initial follow-up appointments for 38 (70.4%) RNA-positive individuals successfully contacted, and 21 (55.3%) individuals with confirmed appointments attended their initial visit with a liver specialist; three (7.9%) are awaiting an upcoming scheduled appointment. Conclusion: We observed high prevalence of unrecognized chronic HCV infection in this series of baby boomers presenting to the ED highlighting the ED as an important venue for high-impact HCV screening and linkage to care.