Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department
Background. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estim...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2020/5258289 |
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| author | Kelsey Ragan Anjali Pandya Tristan Holotnak Katrina Koger Neil Collins Mark G. Swain |
| author_facet | Kelsey Ragan Anjali Pandya Tristan Holotnak Katrina Koger Neil Collins Mark G. Swain |
| author_sort | Kelsey Ragan |
| collection | DOAJ |
| description | Background. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. Methods. A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. Results. Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9–7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care. |
| format | Article |
| id | doaj-art-d7418683df7d467a940d0b8ab330b471 |
| institution | Kabale University |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-d7418683df7d467a940d0b8ab330b4712025-02-03T01:27:03ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972020-01-01202010.1155/2020/52582895258289Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency DepartmentKelsey Ragan0Anjali Pandya1Tristan Holotnak2Katrina Koger3Neil Collins4Mark G. Swain5Department of Emergency Medicine, University of Calgary, Calgary, AB, CanadaDepartment of Emergency Medicine, University of Calgary, Calgary, AB, CanadaCumming School of Medicine, University of Calgary, Calgary, AB, CanadaDepartment of Emergency Medicine, University of Calgary, Calgary, AB, CanadaDepartment of Emergency Medicine, University of Calgary, Calgary, AB, CanadaDivision of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB, CanadaBackground. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. Methods. A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. Results. Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9–7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.http://dx.doi.org/10.1155/2020/5258289 |
| spellingShingle | Kelsey Ragan Anjali Pandya Tristan Holotnak Katrina Koger Neil Collins Mark G. Swain Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department Canadian Journal of Gastroenterology and Hepatology |
| title | Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department |
| title_full | Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department |
| title_fullStr | Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department |
| title_full_unstemmed | Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department |
| title_short | Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department |
| title_sort | hepatitis c virus screening of high risk patients in a canadian emergency department |
| url | http://dx.doi.org/10.1155/2020/5258289 |
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