title: Primary care-based interventions are associated with increases in hepatitis C virus testing for patients at risk.
abstract: BACKGROUND
  An estimated 3.2 million persons are chronically infected with the hepatitis C virus (HCV) in the U.S. Effective treatment is available, but approximately 50% of patients are not aware that they are infected. Optimal testing strategies have not been described.
  
  
  METHODS
  The Hepatitis C Assessment and Testing Project (HepCAT) was a serial cross-sectional evaluation of two community-based interventions designed to increase HCV testing in urban primary care clinics in comparison with a baseline period. The first intervention (risk-based screener) prompted physicians to order HCV tests based on the presence of HCV-related risks. The second intervention (birth cohort) prompted physicians to order HCV tests on all patients born within a high-prevalence birth cohort (1945-1964). The study was conducted at three primary care clinics in the Bronx, New York.
  
  
  RESULTS
  Both interventions were associated with an increased proportion of patients tested for HCV from 6.0% at baseline to 13.1% during the risk-based screener period (P<0.001) and 9.9% during the birth cohort period (P<0.001).
  
  
  CONCLUSIONS
  Two simple clinical reminder interventions were associated with significantly increased HCV testing rates. Our findings suggest that HCV screening programs, using either a risk-based or birth cohort strategy, should be adopted in primary care settings so that HCV-infected patients may benefit from antiviral treatment.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. alitwin@montefiore.org
authors.forename: Alain H
authors.initials: AH
authors.lastname: Litwin
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.forename: Diane
authors.initials: D
authors.lastname: McKee
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: Elisa
authors.initials: E
authors.lastname: Koppelman
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Christiansen
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Weinbaum
authors.forename: William N
authors.initials: WN
authors.lastname: Southern
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000821:virology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009519:New York City; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D017010:Reminder Systems; D012307:Risk Factors; D019037:Urban Health Services / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data