Year of Publication

2016

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Sarah Wackerbarth, PhD

Committee Member

Julia Costich, JD, PhD

Committee Member

Richard Ingram, DrPH

Abstract

Aim: To evaluate the prevalence of previously undiagnosed hepatitis C virus and associated patient risk factors in an urban ED through a universal, integrated screening program, to contextualize results found in terms of gaps in existing HCV screening models and to inform future sustainable and effective screening models.

Methods: ED patients, ages 18-71, that were medically stable, hadn’t had a prior HCV test, and were having blood drawn as part of routine clinical care, were offered (n=2,726) an anti-HCV test, of whom 1,945 accepted. An assessment of correlates to anti-HCV positivity was completed using a binomial logistic regression model.

Results: Approximately, 12.5% (n=241) of patients tested (n=1,923) were anti-HCV positive. Among birth-cohort patients, 18.7% (n=154) tested positive. Specifically, holding all else constant, patients within the birth-cohort were associated with odds of having anti-HCV positivity 13.1 (CI: 7.5-22.9) times higher than those born outside the birth-cohort. Notably, approximately 5.8% (n=14) of patients who were anti-HCV positive had no documented risk factors. After controlling for all other variables, anti-HCV positivity was associated with patients within the birth-cohort, males, PWID, and persons living with HIV (PLWH).

Conclusion: The anti-HCV prevalence found in the JHBMC ED was high and comparable to that documented in other urban EDs throughout the country. This study demonstrates the unique capacity of EDs to reach previously missed or unacknowledged cases of hepatitis C. ED HCV screening models should be further piloted and evaluated throughout the country, as they might serve as critical safety-nets in the effort to curb this silent, costly epidemic.

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