title: Comparison of hepatitis C virus testing strategies: birth cohort versus elevated alanine aminotransferase levels.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is unidentified in an estimated 40%-85% of infected adults. Surveillance and modeling data have found significant increases in HCV-associated morbidity and mortality.
  
  
  OBJECTIVE
  To compare two HCV antibody (anti-HCV) testing strategies based on (1) elevated alanine aminotransferase levels (ALT) and (2) a birth cohort approach for people born during 1945-1965.
  
  
  METHODS
  Data from 19,055 adults aged 20-70 years who completed the National Health and Nutrition Examination Survey in 1999-2008 were analyzed in 2013. Two independent models were evaluated, based on membership in the 1945-1965 birth cohort or elevated ALT, to compare the number of identified anti-HCV-positive (anti-HCV+) individuals; proportion of total identified cases; and the number of people that would be tested using either strategy.
  
  
  RESULTS
  The prevalence of anti-HCV among adults aged 20-70 years was estimated at 2.0% (95% CI=1.8%, 2.3%), representing about 3.6 million people. The birth cohort strategy would result in testing about 85.4 million people and identifying nearly 2.8 million anti-HCV+ people with a sensitivity of 76.6%. The ALT strategy would test about 21.5 million adults and identify approximately 1.8 million anti-HCV+ people with a sensitivity of 50.0%. Implementing both strategies concurrently would identify 87.3% of anti-HCV+ adults.
  
  
  CONCLUSIONS
  The birth cohort strategy, which is recommended by both the CDC and the U.S. Preventive Services Task Force, would identify 1 million more anti-HCV+ people than the elevated ALT approach. Concurrent implementation would identify an even larger number of individuals ever infected.
authors.affiliation: CDC, Atlanta, Georgia. Electronic address: bsmith6@cdc.gov.
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: CDC Foundation, Atlanta, Georgia.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Yartel
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies; D000410:Alanine Transaminase