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Although we have highly effective therapies for the treatment of chronic hepatitis C virus (HCV) infection, case identification is critical so that patients can be linked to care. Although one-time HCV testing for individuals born between 1945 and 1965, or birth cohort screening, has been recommended in the U.S., effectiveness data are sparse.
In three randomized, controlled trials, researchers assessed the probability of identifying undiagnosed HCV infection using a birth cohort screening method (three different methods at three different academic centers) compared with usual care. Patients without a previous history of HCV testing received a one-time screening offer via repeated mailings, direct patient solicitation by trained recruiters directly following a primary care clinic visit, or an electronic health record (EHR)–integrated best-practice alert prompt at the time of a clinic visit.
In all three trials — the repeated mailings trial (approximately 9000 patients), the patient solicitation trial (approx. 8900), and the EHR best-practice alert trial (approx. 15,000), the interventions were eight, five, and three times more effective, respectively, at identifying HCV cases compared with usual care.
Yartel AK et al. Hepatitis C virus testing for case identification in persons born during 1945–1965: Results from three randomized controlled trials. Hepatology 2017 Sep 23; [e-pub]. (http://dx.doi.org/10.1002/hep.29548)
Comment
These findings clearly demonstrate that birth cohort screening is superior to usual risk-based methods for identifying patients with HCV infection. A next reasonable research step would be to directly compare implementation costs of these different screening approaches to determine which method is most cost effective to implement in the primary care setting.