Abstract
Objectives
We implemented the “High-Impact Testing for Injection Drug Users”, or the “HIT IDU”
initiative, an emergency physician (EP)–based hepatitis C virus (HCV) testing program.
The objective of this study was to evaluate the outcomes of this clinical protocol.
Methods
This was a prospective observational pilot study. The HIT IDU initiative encouraged
EPs to integrate targeted HCV testing into care, with an emphasis on screening all
people who inject drugs (PWID). Physicians selected the primary indication for HCV
testing from a drop-down menu integrated into the electronic ordering process. The
primary outcome was the absolute number and overall proportion of EP-based HCV antibody
positive tests, further stratified by the indication for testing.
Results
Over the 3-month study period, 14,253 unique patients were evaluated, and EPs tested
155 patients for HCV (1.1%; 95% confidence interval [CI], 0.9%-1.2%), of which 40
(26%, 95% CI, 19%-33%) were HCV antibody positive. The proportion of HCV antibody
positivity by testing indication was as follows: PWID 47% (34/73; 95% CI, 35%-59%),
patient requested test 10% (4/40; 95% CI, 3%-24%), confirm patient report 67% (2/3;
95% CI, 9%-99%), liver disease of uncertain etiology 0% (0/3; 95% CI, 0%-71%), and
other 0% (0/36; 95% CI, 0%-10%). There were 22 patients chronically infected, 19 had
a follow-up appointment arranged, 3 attended their follow-up appointment, and 1 patient
was treated at 1 year of follow-up.
Conclusions
Although the overall number of EP-based HCV tests performed was low, high rates of
infection were identified, particularly among PWID. There were significant challenges
with linkage to care.
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References
- The prevalence of hepatitis C virus infection in the United States, 1999 through 2002.Ann Intern Med. 2006; 144: 705-714
- Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition examination survey 2001–2008.Hepatology. 2012; 55: 1652-1661
- Screening for hepatitis c virus infection in adults: U.S. Preventative Services Task Force recommendation statement.Ann Intern Med. 2013; 159: 349-357
- The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007.Ann Intern Med. 2012; 156: 271-278
- Increases in hepatitis C virus infection related to injection drug use among persons aged ≤ 30 years—Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012.MMWR Morb Mortal Wkly Rep. 2015; 64: 453-458
- Confronting the emerging epidemic of HCV Infection among young injection drug users.Am J Public Health. 2014; 104: 816-821
- Emergency department utilization among a cohort of HIV-positive injecting drug users in a Canadian setting.J Emerg Med. 2012; 43: 236-243
- Hospital utilization and costs in a cohort of injection drug users.Can Med Assoc J. 2001; 165: 415-420
- Hospitalizations for metabolic conditions, opportunistic infections, and injection drug use among HIV patients: trends between 1996 and 2000 in 12 states.J Acquir Immune Defic Syndr. 2005; 40: 609-616
- Results of a rapid hepatitis C virus screening and diagnostic testing program in an urban emergency department.Ann Emerg Med. 2016; 67: 119-128
- Development and implementation of a model to improve identification of patients infected with HIV Using diagnostic rapid testing in the emergency department.Acad Emerg Med. 2007; 14: 1149-1157
- Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department.Hepatology. 2015; 61: 776-782
- Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department.Acad Emerg Med. 2009; 16: 1078-1088
- A promising approach for emergency departments to care for patients with substance use and behavioral disorders.Health Aff (Millwood). 2013; 32: 2122-2128
- SBIRT in emergency care settings: are we ready to take it to scale?.Acad Emerg Med. 2009; 16: 1072-1077
- Hepatitis C virus infection in the 1945–1965 birth cohort (baby boomers) in a large urban emergency department.Am J Emerg Med. 2016; 34 ([available online]): 697-701https://doi.org/10.1016/j.ajem.2015.12.072
- Hepatitis C virus treatment for prevention among people who inject drugs: modeling treatment scale-up in the age of direct-acting antivirals.Hepatology. 2013; 58: 1598-1609
Article Info
Publication History
Published online: March 03, 2016
Accepted:
March 1,
2016
Received in revised form:
March 1,
2016
Received:
January 11,
2016
Footnotes
☆Author contributions: ESA and DAEW conceived the study, and DAEW obtained research funding. DAEW, ESA, and SKP designed the study. DAEW, ESA, and SKP supervised study administration, and ESA, SKP, and LJD managed the data. ESA provided statistical advice and analyzed the data. ESA drafted the manuscript, and all authors contributed substantially to its revision. ESA takes responsibility for the manuscript as a whole.
☆☆Prior presentations: none.
★Grants: HIV FOCUS Grant, Gilead Sciences .
★★Disclosures: The Principal Investigator and Research Staff (DAEW, SKP, LJD, and TT) received HIV FOCUS grant funding from Gilead Sciences for partial salary and administrative support. Gilead Sciences had no role in study design, results interpretation, or manuscript preparation.
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© 2016 Elsevier Inc. All rights reserved.
