High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments — Birmingham, Oakland, Baltimore, and Boston, 2015–2017

Abstract

non-Hispanic whites (whites) (12.2%) (p<0.001). Among persons born after 1965, overall prevalence of positive results for anti-HCV was 6.7% and was significantly higher among whites (15.3%) than among blacks (3.2%) (p<0.001). These findings highlight age-associated differences in racial/ethnic prevalences and the potential for ED venues and opt-out, universal testing strategies to improve HCV infection awareness and surveillance for hard-to-reach populations. This opt-out, universal testing approach is supported by new recommendations for hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of positive results for HCV infection is <0.1% (7). A retrospective study from four urban academic EDs located in Birmingham, Alabama; Oakland, California; Boston, Massachusetts; and Baltimore, Maryland was conducted with approval from each institution's local Institutional Review Board. Each ED implemented opt-out, universal hepatitis C testing at different times and using differing methodologies among patients who reported no history of HCV infection. The period of observation for this study was 4 months, starting 1 month after initial implementation of opt-out, universal hepatitis C screening. Because of programmatic changes during the observation period at Johns Hopkins ED, only 3 months of observation is reported. All sites used the Abbott Architect anti-HCV assay (Abbott Diagnostics) for testing, with results available during the ED visit, and reflex HCV RNA testing performed on specimens collected during the ED encounter from persons with anti-HCV positive results. Each site used dedicated linkage-to-care coordinators to deliver positive test results and facilitate referral to HCV infection care. ED sites collected cumulative hepatitis C testing outcomes for the 4-month study period, including cumulative anti-HCV results stratified by birth year, race/ethnicity, sex, and insurance type. Deidentified data were collected for aggregation and analysis at the University of Alabama at Birmingham site. Patient characteristics and prevalence estimates for positive results for anti-HCV were reported with 95% confidence intervals across sites. P-values <0.05 were considered statistically significant. STATA (version 15.1; StataCorp) was used to conduct all statistical analyses. Using opt-out, universal hepatitis C screening (Table 1), EDs performed a total of 14,252 tests on unique visitors, and 1,315 (9.2%) had positive test results for anti-HCV (Table 2). HCV RNA testing for current infection was performed for 1,118 (85%) visitors with positive test results for anti-HCV, and 693 (62%) of these persons had positive HCV RNA test results, indicating current HCV infection. The prevalence of positive results for anti-HCV was higher among persons in the 1945-1965 birth cohort (13.9%) than among those in the cohort born after 1965 (6.7%); however, the younger cohort accounted for 47.8% (628 of 1,315) of total cases reactive to anti-HCV identified. Significant differences in positive results for anti-HCV by birth cohort and race/ethnicity were identified (Table 3). Among persons born during 1945-1965, overall positive results for anti-HCV prevalence was significantly higher among