Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4878
Peer-review started: May 20, 2020
First decision: June 4, 2020
Revised: June 13, 2020
Accepted: August 9, 2020
Article in press: August 9, 2020
Published online: August 28, 2020
Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease worldwide. In the last few years, new treatments for HCV have revolutionized management of this infection.
A major obstacle to viral elimination is identifying asymptomatic infected patients. Most screening strategies focus on high-risk patients, while others target the general population. Prior studies showed that HCV prevalence in emergency department attendees is higher than the general population.
A single center prospective study, aimed at identifying undiagnosed HCV carriers among high risk emergency room attendees and linking them to anti-viral treatment.
Persons visiting the emergency department were screened by a 9-question risk factor-specific questionnaire. Those with at least one risk factor were tested for HCV with blood and saliva antibody tests.
Five hundred and forty-one participants were tested for HCV. Eighty five percent of participants underwent saliva testing, 34% were tested for serum antibodies, and 25% had both tests. 17 patients (3.1%) had a positive result, compared to local population incidence of 1.96%. Eighty two percent of patients with positive HCV were people who inject drugs, and 64% served time in prison. Twelve patients were found to have been previously diagnosed with HCV but were unaware of the diagnosis. At 1-year follow-up, only one patient completed HCV-RNA testing and was found negative. None of the remaining patients completed the recommended testing, visited a hepatology clinic or received anti-viral treatment.
Targeted high-risk screening in the emergency department identified undiagnosed and untreated HCV carriers, but did not improve treatment rates.
This study suggests that in order to achieve viral elimination, other avenues need to be explored to find a framework that will enable treatment completion for this population.