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Hossain N, Puchakayala B, Kanwar P, Verma S, Abraham G, Ivanov Z, Niaz MO, Mohanty SR. Risk Factor Analysis Between Newly Screened and Established Hepatitis C in GI and Hepatology Clinics. Dig Dis Sci 2017; 62:3193-3199. [PMID: 28913613 DOI: 10.1007/s10620-017-4754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 06/11/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Several studies show inconsistencies in the rate of hepatitis C virus (HCV) detection among baby boomers (born 1945-1965). We conducted a cross-sectional HCV screening followed by a case-controlled comparison of the newly screened population with established HCV subjects. METHOD Enrollment was offered to subjects aged 40-75 at our gastroenterology and hepatology clinics. Demographic data and potential risk factors were obtained, and HCV antibody test was offered to those who had never been screened and compared with a group with established HCV. Logistic regression analysis and Fisher's exact test were performed. RESULTS Six hundred and seventy-five patients were offered participation, of whom 128 declined while 50 consented to participate but did not perform the HCV antibody test. Of 497 enrolled subjects, 252 patients had HCV, while 245 subjects (188 patients among "baby boomer") underwent screening for HCV. There were more females (62.4 vs. 41.7%) and immigrants (34.7 vs. 22.2%) among the newly screened group. Among the screened population, five patients had HCV antibody (2.04%), and two of them had positive viral load (0.82%) of whom only one fell in the baby boomer category (0.53%). Compared to HCV group, screened group had significantly lower-risk factors, such as IV drug use (1.22 vs. 43.3%), intranasal cocaine use (14.3 vs. 49.6%), and blood transfusion (18.8 vs. 32.5%). CONCLUSION We found a slightly lower but similar prevalence of HCV antibody when screening based on birth cohort as compared to larger baby boomer studies. Future studies evaluating addition of other screening strategies or possibly universal screening may be needed.
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Affiliation(s)
- Newaz Hossain
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Bharat Puchakayala
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Pushpjeet Kanwar
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Siddharth Verma
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA.,Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mt Sinai, Queens Hospital Center, 82-68, 164th Street, Queens, NY, 11432, USA
| | - George Abraham
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Zhanna Ivanov
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Muhammad Obaid Niaz
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Smruti R Mohanty
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA.
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Golden MR, Duchin J, Chew LD, Huntington JH, Sugg N, Jackson S, Lane A, Pecha M, Barash E, Scott J. Impact of an Electronic Medical Record-Based System to Promote Human Immunodeficiency Virus/Hepatitis C Virus Screening in Public Hospital Primary Care Clinics. Open Forum Infect Dis 2017; 4:ofx075. [PMID: 28584856 PMCID: PMC5450882 DOI: 10.1093/ofid/ofx075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/05/2017] [Indexed: 12/31/2022] Open
Abstract
Background United States guidelines recommend that all adolescents and adults be tested for human immunodeficiency virus (HIV) and that persons born between 1945 and 1965 be tested for hepatitis C virus (HCV). Methods We used electronic medical record (EMR) data to identify patients in 3 primary care clinics in Seattle, Washington who met national criteria for routine HCV or HIV testing and had no documented history of prior testing. Clinic staff received daily lists of untested patients with scheduled appointments. We used generalized linear models to compare the percentage of patients tested and newly diagnosed with HIV and HCV in the 18 months before and during the intervention. Results A total of 16784 patients aged 18–64 and 9370 patients born between 1945 and 1965 received care from January 2011 to December 2015. Comparing the preintervention and intervention periods, the percentage of previously untested patients tested for HIV and HCV increased from 14.9% to 30.8% and from 18.0% to 35.5%, respectively (P < .0001 for both). Despite this increase in testing, there was no change in the percentage of patients newly diagnosed with HIV (0.7% in both periods, P = .96) or HCV (3.6% vs 3.7%, P = .81). We estimate that 1.2%–15% of HCV-infected primary care patients in our medical center are undiagnosed. Conclusions EMR-based HCV/HIV testing promotion increased testing but not case finding among primary care patients in our medical center. In our institution, most HCV-infected patients are already diagnosed, primarily through risk-based and clinical screening, highlighting the need to concentrate future efforts on increasing HCV treatment.
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Affiliation(s)
- Matthew R Golden
- Division of Infectious Diseases, Department of Medicine.,Public Health - Seattle & King County, Washington.,Harborview Medical Center, Seattle, Washington
| | - Jeffery Duchin
- Division of Infectious Diseases, Department of Medicine.,Public Health - Seattle & King County, Washington.,Harborview Medical Center, Seattle, Washington
| | - Lisa D Chew
- Department of Medicine, and.,Harborview Medical Center, Seattle, Washington
| | - Jane H Huntington
- Department of Family Medicine, University of Washington, Seattle.,Harborview Medical Center, Seattle, Washington
| | - Nancy Sugg
- Department of Medicine, and.,Harborview Medical Center, Seattle, Washington
| | - Sara Jackson
- Department of Medicine, and.,Harborview Medical Center, Seattle, Washington
| | - Aric Lane
- Public Health - Seattle & King County, Washington
| | - Monica Pecha
- Public Health - Seattle & King County, Washington
| | | | - John Scott
- Division of Infectious Diseases, Department of Medicine.,Harborview Medical Center, Seattle, Washington
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