title: Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts.
abstract: OBJECTIVE
  Guidelines recommend hepatitis C virus (HCV) screening for all people living with HIV (PLWH). Understanding HCV testing practices may improve compliance with guidelines and can help identify areas for future intervention.
  
  
  METHODS
  We evaluated HCV screening and unnecessary repeat HCV testing in 8,590 PLWH initiating care at 12 U.S. HIV clinics between 2006 and 2010, with follow-up through 2011. Multivariable logistic regression examined the association between patient factors and the outcomes: HCV screening (≥1 HCV antibody tests during the study period) and unnecessary repeat HCV testing (≥1 HCV antibody tests in patients with a prior positive test result).
  
  
  RESULTS
  Overall, 82% of patients were screened for HCV, 18% of those screened were HCV antibody-positive, and 40% of HCV antibody-positive patients had unnecessary repeat HCV testing. The likelihood of being screened for HCV increased as the number of outpatient visits rose (adjusted odds ratio 1.02, 95% confidence interval 1.01-1.03). Compared to men who have sex with men (MSM), patients with injection drug use (IDU) were less likely to be screened for HCV (0.63, 0.52-0.78); while individuals with Medicaid were more likely to be screened than those with private insurance (1.30, 1.04-1.62). Patients with heterosexual (1.78, 1.20-2.65) and IDU (1.58, 1.06-2.34) risk compared to MSM, and those with higher numbers of outpatient (1.03, 1.01-1.04) and inpatient (1.09, 1.01-1.19) visits were at greatest risk of unnecessary HCV testing.
  
  
  CONCLUSIONS
  Additional efforts to improve compliance with HCV testing guidelines are needed. Leveraging health information technology may increase HCV screening and reduce unnecessary testing.
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Ramin S
authors.initials: RS
authors.lastname: Herati
authors.affiliation: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, United States of America.
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.affiliation: Southwest Care Center, Santa Fe, New Mexico, United States of America.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Gallant
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Berry
authors.affiliation: Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, United States of America.
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000821:virology*; D006301:Health Services Needs and Demand; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000276:immunology* / Q000821:virology*; D018937:Hepatitis C Antibodies / Q000276:immunology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012306:Risk; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000276:immunology / Q000821:virology; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies