title: A Birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks: a cross-sectional study.
abstract: BACKGROUND
  International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy.
  
  
  METHODS
  We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project.
  
  
  RESULTS
  Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5% vs. 49.5%, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0% vs. 46.7%, p = 0.002), or the composite any risk-associated factor (55.9% vs. 79.0%, p = 0.002).
  
  
  CONCLUSIONS
  Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.
authors.affiliation: Division of Hospital Medicine, 111 East 210th Street, Bronx, 10467, NY, USA. wsouther@montefiore.org.|Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA. wsouther@montefiore.org.|Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA. wsouther@montefiore.org.
authors.forename: William N
authors.initials: WN
authors.lastname: Southern
authors.affiliation: Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA. bnorton@montefiore.org.|Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA. bnorton@montefiore.org.
authors.forename: Brianna
authors.initials: B
authors.lastname: Norton
authors.affiliation: Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA. mesteinm@montefiore.org.|Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA. mesteinm@montefiore.org.
authors.forename: Meredith
authors.initials: M
authors.lastname: Steinman
authors.affiliation: Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.|Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: DeLuca
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA. drainoni@bu.edu.
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/Viral Hepatitis/STD/TB Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA. Bli1@cdc.gov.
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA. alitwin@montefiore.org.|Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA. alitwin@montefiore.org.
authors.forename: Alain H
authors.initials: AH
authors.lastname: Litwin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D016174:Hepacivirus / Q000276:immunology / Q000472:pathogenicity; D006526:Hepatitis C / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009518:New York; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States
chemical_list: D018937:Hepatitis C Antibodies