Hepatitis C screening trends in a large integrated health system.
BACKGROUND
As new hepatitis C virus (HCV) therapies emerge, only 1%-12% of individuals are screened in the US for HCV infection. Presently, HCV screening trends are unknown.


METHODS
We utilized the Kaiser Permanente Mid-Atlantic States' (KPMAS) data repository to investigate HCV antibody screening between January 1, 2003 and December 31, 2012. We identified the proportion screened for HCV and 5-year cumulative incidence of screening, the screening positivity rate, the provider types performing HCV screening, patient-level factors associated with being screened, and trends in screening over time.


RESULTS
There were 444,594 patients who met the inclusion criteria. Overall, 15.8% of the cohort was ever screened for HCV. Adult primary care and obstetrics and gynecology providers performed 75.9% of all screening. The overall test positivity rate was 3.8%. Screening was more frequent in younger age groups (P <.0001) and those with a documented history of illicit drug use (P <.0001). Patients with missing drug use history (46.7%) were least likely to be screened (P <.0001). While the rate of HCV screening increased in the later years of the study among those enrolled in KPMAS 2009-2012, only 11.8% were screened by the end of follow-up.


CONCLUSIONS
Screening for HCV is increasing but remains incomplete. Targeting screening to those with a history of injection drug will not likely expand screening, as nearly half of patients have no documented drug use history. Routine screening is likely the most effective approach to expand HCV screening.
HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, Mass; Department of Epidemiology, Boston University School of Public Health, Boston, Mass. Electronic address: Benjamin.Linas@BMC.org.
Benjamin P
BP
Linas
Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Md.
Haihong
H
Hu
HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, Mass.
Devra M
DM
Barter
Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Md.
Michael
M
Horberg
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D018937:Hepatitis C Antibodies / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008873:Mid-Atlantic Region / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012367:RNA, Viral / Q000302:isolation & purification; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*
D018937:Hepatitis C Antibodies; D012367:RNA, Viral
Hepatitis C virus; Screening rates; Screening trends