Clinical Practice Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2018; 10(2): 319-328
Published online Feb 27, 2018. doi: 10.4254/wjh.v10.i2.319
Hepatitis C virus knowledge improves hepatitis C virus screening practices among primary care physicians
Sandeep T Samuel, Anthony D Martinez, Yang Chen, Marianthi Markatou, Andrew H Talal
Sandeep T Samuel, Anthony D Martinez, Andrew H Talal, Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY 14203, United States
Yang Chen, Marianthi Markatou, Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, NY 14214, United States
Author contributions: Samuel ST, Martinez AD and Talal AH contributed to conception of the study, obtaining regulatory approval, data collection and input on the analysis; Chen Y and Markatou M contributed to direction and conduct of statistical analysis; all authors contributed to drafting and approval of final manuscript.
Supported by Troup Fund of the Kaleida Health Foundation and the Patient-Centered Outcomes Research Institute (PCORI), NO. IHS-1507-31640. The statements in this work are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.
Institutional review board statement: The Health Sciences Institutional Review Board (HSIRB) at the University at Buffalo reviewed the study protocol and deemed the study met exempt criteria 45 CFR 46.101(b)(2). The permissible exempt category was “Research involving the use of educational tests, survey procedures, interview procedures or observation of public behavior (anonymous survey)”.
Informed consent statement: The HSIRB considered the return of the anonymous survey as deemed voluntary consent to participate in the study and therefore did not require an individual consent form from each participant.
Conflict-of-interest statement: Martinez AD has served as a speaker, a consultant and an advisory board member for Gilead, Intercept, Salix, Bayer, BMS, and Abbvie, and has received research funding from Abbvie, Gilead, Merck, Tobira, and Intercept; Talal AH has served as a speaker, a consultant and an advisory board member for Abbott Laboratories, Merck, and Abbvie, and has received research funding from Merck, Gilead, Abbott Laboratories, Abbvie, Intercept and Conatus; None of the other authors have any financial disclosures.
Data sharing statement: HSIRB approval permitted data sharing of the results of the study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Andrew H Talal, MD, Professor of Medicine, Department of Medicine, University at Buffalo, State University of New York, 875 Ellicot Street, Suite 6090, Buffalo, NY 14203, United States.
Telephone: +1-716-8296208 Fax: +1-716-8541397
Received: January 1, 2018
Peer-review started: January 2, 2018
First decision: January 15, 2018
Revised: January 17, 2018
Accepted: February 3, 2018
Article in press: February 3, 2018
Published online: February 27, 2018

To understand the role of knowledge as a promoter of hepatitis C virus (HCV) screening among primary care physicians (PCP).


A 45-item online questionnaire assessing knowledge of HCV natural history, risk factors, and treatment was distributed to 163 PCP. Logistic regression, adjusted for survey responses, assessed associations between PCP knowledge of HCV natural history and treatment and birth cohort (i.e., birth between 1945 and 1965) screening. Response stratification and weighting were used to account for nonresponse and to permit extension of responses to the entire survey population. Associations between various predictors including demographic characteristics, level of training, and HCV treatment experience and HCV knowledge were assessed.


Ninety-one individuals (55.8%) responded. Abnormal liver enzymes (49.4%), assessment of HCV-related risk factors (30.6%), and birth cohort membership (20%) were the leading HCV screening indications. Most PCP (64.7%) felt that the combination of risk-factor and birth cohort screening utilizing a self-administered survey while awaiting the physician (55.3%) were the most efficient screening practices. Implementation of birth cohort screening was associated with awareness of the recommendations (P-value = 0.01), knowledge of HCV natural history (P-value < 0.01), and prior management of HCV patients (P-value < 0.01). PCP with knowledge of HCV treatment was also knowledgeable about HCV natural history (P-value < 0.01). Similarly, awareness of age-based screening recommendations was associated with HCV treatment knowledge (P-value = 0.03).


Comprehensive knowledge of HCV is critical to motivate HCV screening. PCP-targeted educational interventions are required to expand the HCV workforce and linkage-to-care opportunities as we seek global HCV eradication.

Keywords: Viral hepatitis, Hepatitis C virus global eradication, Hepatitis C virus diagnosis, Hepatitis C virus surveillance, Knowledge of hepatitis C virus

Core tip: Many hepatitis C virus (HCV)-infected patients worldwide are unaware of their infection status. The key to increasing HCV detection and linkage-to-care is augmentation of virus screening by primary care physicians (PCP). Understanding factors that promote HCV screening among PCP is crucial to its eradication. We assessed PCP knowledge of HCV natural history and treatment and awareness of screening recommendations. PCP knowledge of HCV natural history and prior management of HCV patients were important predictors of implementation of HCV screening. Comprehensive HCV education targeted to PCP, including screening recommendations, is critical to increase HCV detection and linkage-to-care to obtain global eradication.