Universal HCV Screening of Baby Boomers is Feasible, but It is Difficult

Paul J Thuluvath; Joshua Trowell; Talan Zhang; Joseph Alukal; George Lowe

doi:10.1016/j.jceh.2021.02.007

Universal HCV Screening of Baby Boomers is Feasible, but It is Difficult

J Clin Exp Hepatol. 2021 Nov-Dec;11(6):661-667. doi: 10.1016/j.jceh.2021.02.007. Epub 2021 Feb 25.

Authors

Paul J Thuluvath^{1

2}, Joshua Trowell¹, Talan Zhang¹, Joseph Alukal¹, George Lowe¹

Affiliations

¹ Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
² Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, 21202, USA.

Abstract

Background/objective: Our objective was to assess the impact of mass mailing and the inclusion of Best Practice Advisory (BPA) "Pop-Up" tool in the electronic medical record (EMR) on HCV screening rates.

Methods: Between June 2015 and March 2020, two interventions were developed for primary care physicians (PCP). An educational letter along with a blood requisition form, signed on behalf of the PCPs, was sent to patients. We also developed a BPA "Pop-Up" screening tool to alert PCPs to order HCV screening tests on patients with no previous screening. Data were collected and analyzed prospectively.

Results: When we started the screening program in June 2015, 33,736 baby boomers were eligible for screening, and the hospital system added an additional 26,027 baby boomers between June 2015 and March 2020. Of the 89 primary care providers employed by the hospital, 75 agreed to participate at different time periods. We screened 23,291 (43.5%) of 53,526 eligible patients during study period. Of these, 399 (1.7%) had HCV antibody, but HCV RNA was positive in only 195 (1%). HCV antibody positivity rates were higher in men, blacks, and in 1951-1960 birth cohorts. Spontaneous clearance rates appeared to be lower in men (OR 0.59, 95% CI 0.39-0.90, P = 0.015) and in blacks (OR 0.31, 95% CI 0.20-0.50, P < 0.001).

Conclusion: Although a formal screening program increased screening rates for HCV among baby boomers, about 50% of baby boomers remained unscreened. In this community screening program, we found that men and blacks are less likely to have spontaneous HCV clearance.

Keywords: BPA, Best Practice Advisory; DAA, Direct Acting Anti-viral; EMR, Electronic Medical Record; HCV eradication; HCV linkage to care; HCV screening; HCV, Hepatitis C Virus; IT, Information Technology; education; electronic; hepatitis C Virus (HCV); letters.