Inexpensive Intervention Associated with Increased HCV Screening Rates

Tess Peterson, MD

Simple interventions within primary care practices have the potential to increase screening for Hepatitis C Virus (HCV) infection, according to a new study.

A team led by Tess Peterson, MD, Department of Internal Medicine, Lankenau Medical Center, conducted a quality improvement study to assess the impact of Centers for Disease Control (CDC) HCV infographic campaign posters on HCV screening rates, GI clinical referral rates, and—ultimately—curative treatment.

“With advances in Hepatitis C Virus infection treatment resulting cures in more than 95% of patients, primary care practices should be screening all patients born between 1945 and 1965 as indicated by the Centers for Disease Control and U.S. Preventive Services Task Force recommendations,” they wrote.

The infographic used in the study consisted of a visual reminder to screen patients as well as a resource on who should be screened. Thus, the intervention was implemented at the start of the 2017 calendar year.

Peterson and team then performed a chart review of visits from the 2016 calendar year (pre-intervention) and compared the results with the post-intervention 2017 calendar. Only patients born between 1945-1965 were included in the reviews.

Thus, in 2016, a total of 250 patient charts were assessed. Of the population, 27% were screened for HCV—versus 38% of 335 patients in the 2017 cohort. (P = .0006).

The team also reported that the 2017 cohort was 42% more likely to receive an HCV antibody order (RR, 1.42; 95% CI, 1.07-1.87; P = .011).

They further evaluated those who screened positive for HCV to determine the efficacy of internal medicine HCV screening as well as referrals to GI clinic for treatment.

In the pre-intervention group, 5 patients screened positive for HCV, but 4 (80%) were referred to the GI clinic. The investigators noted that the outstanding patient received a negative PCR. As a result, they did not require referral.

As for those in the post-intervention group, only 2 patients tested positive for the virus. Both (100%) were referred to the GI clinic.

Of all 7 who screened positive, 3 were treated with glecaprevir/pibrentasvir, and 2 were treated with elbasvir/grazoprevir.

Furthermore, 5 (3 from 2016, 2 from 2017) achieved sustained virologic response 24 weeks following completion of therapy. These patients remained in the same health system for treatment.

“Our study demonstrates that internal medicine residency clinics can increase Hepatitis C screening numbers by an easy, inexpensive method,” they wrote. “Further, we demonstrate that by increasing screening we have increased the number of patients referred to GI and cured of HCV.”

The study, “Efficacy of Internal Medicine Clinic HCV Screening and Referral to GI Clinic for Treatment,” was published online by ACG.