title: Results of a Rapid Hepatitis C Virus Screening and Diagnostic Testing Program in an Urban Emergency Department.
abstract: OBJECTIVE
  We describe the results of an emergency department (ED) hepatitis C virus testing program that integrated birth cohort screening and screening of patients with a history of injection drug use, as well as physician diagnostic testing, according to national guidelines.
  
  
  METHODS
  We conducted a retrospective cohort study using data collected as part of clinical care. The primary outcome was the hepatitis C virus prevalence among tested patients. We evaluated factors associated with testing positive with logistic regression.
  
  
  RESULTS
  Of the 26,639 unique adults aged 18 years or older and presenting to the ED during the 6-month study, 2,581 (9.7%) completed hepatitis C virus screening (2,028) or diagnostic testing (553), of whom 267 were antibody positive (10.3% prevalence). Factors associated with testing positive for hepatitis C virus included injection drug use (38.4% prevalence; odds ratio [OR] 10.8; 95% confidence interval [CI] 7.5 to 15.5), homeless (25.5% prevalence; OR 3.1; 95% CI 1.5 to 6.8), diagnostic testing (14.8% prevalence; OR 2.6; 95% CI 1.7 to 3.9), birth cohort (13.7% prevalence; OR 3.6; 95% CI 2.4 to 5.3), and male sex (12.4% prevalence; OR 1.4; 95% CI 1.0 to 2.0). Of the 267 patients testing positive for hepatitis C virus antibody, 137 (51%) had documentation of result disclosure and 180 (67%) had confirmatory ribonucleic acid testing performed, of whom 126 (70%) had a positive result. Follow-up appointments at the hepatitis C virus clinic were arranged for 57 of the 126 (45%) patients with confirmed positive results, of which 30 attended.
  
  
  CONCLUSIONS
  This ED screening and diagnostic testing program found a high prevalence of hepatitis C virus antibody positivity across all groups. Challenges encountered with hepatitis C virus screening included result disclosure, confirmatory testing, and linkage to care. Our results warrant continued efforts to develop and evaluate policies for ED-based hepatitis C virus screening.
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA. Electronic address: dwhite@alamedahealthsystem.org.
authors.forename: Douglas A E
authors.initials: DA
authors.lastname: White
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Pfeil
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
authors.forename: Tarak K
authors.initials: TK
authors.lastname: Trivedi
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
authors.forename: Harrison J
authors.initials: HJ
authors.lastname: Alter
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014218:Triage; D014481:United States / Q000453:epidemiology