Year: 2019
Type: letter
Abstract: To the Editor—We appreciate Dr MacDonald and colleagues’ [1] interest in our study [2] describing the limited coverage of hepatitis C virus (HCV) testing in the noninstitutionalized US civilian population, even among Baby Boomers, for whom there is a 1-time HCV testing recommendation. Our study was conducted using data from the 2013–2017 National Health Interview Survey. Using the same data source, the authors make an important point that, even in 2017, there were missed opportunities for HCV testing [1]. In particular, the authors highlight that 78% of untested Baby Boomers interacted with a primary care provider in the past year. We agree with MacDonald et al [1] that interventions to improve the uptake of HCV testing recommendations should be implemented in primary care settings (eg, provider and patient education programs, in combination with targeted electronic medical record best practice alerts for providers [3]). We would also like to highlight additional opportunities and settings for improving the coverage of HCV testing. First, the emergency department (ED) is a key component of the traditional healthcare system. EDs commonly provide primary care to individuals who may not have a primary care provider, especially in underserved communities. Although it was less common for untested Baby Boomers to attend an ED in the past year, as compared to having an interaction with a primary care provider or specialist [1], the ED can be a high-yield venue for HCV testing in high-prevalence communities. We and others have previously documented a high burden of HCV infection in ED patients [4–7]. For instance, 25% of Baby Boomers attending the Johns Hopkins Hospital ED had antibodies to HCV [4]. Birth cohort–targeted, opt-out HCV screening and linkage to care (LTC) programs have been successfully implemented in EDs [5], with some EDs also using nontargeted opt-out approaches to improve testing coverage in other high-risk populations [6]. Second, from a public health perspective, it is important to note that the implementation of birth cohort–based and risk-based HCV testing initiatives should not be limited to the traditional healthcare system. Nearly 1 in 5 untested Baby Boomers in 2017 reported no interaction with the traditional healthcare system in the past year [1]. Additionally, data from NHIS are not generalizable to institutionalized populations (eg, persons living in nursing homes and persons who are incarcerated). To reach Baby Boomers and younger high-risk individuals who are not engaged in the traditional healthcare system, it is imperative that HCV testing and LTC programs also be implemented in high-yield, nonmedical institutions and nontraditional healthcare settings, such as senior citizen centers [8], prisons [9], public health clinics [10], opioid treatment programs, and needle/syringe exchange programs [11]. Community- and faith-based organizations have also proven instrumental in expanding HCV testing and LTC programming [12]. Our study emphasizes the need to scale up and successfully implement HCV testing initiatives, particularly in the context of achieving HCV elimination by 2030 [2]. As highlighted by MacDonald and colleagues [1], systems-level interventions are needed to avoid missed opportunities for HCV testing. While we appreciate their settings-based perspective for the prioritization of implementing HCV testing programs, we believe a public health perspective and community-based approach are also needed to effectively improve coverage of HCV testing. Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciz441
Language: French
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: National Institutes of Health
OpenAlex ID: W2945005202