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BACKGROUND: Typically, only positive hepatitis C virus (HCV) test results are reportable to Health Departments; therefore, it has been difficult to create an accurate picture of who is being tested. This study utilizes positive HCV antibody (Ab) results from the Philadelphia Department of Public Health (PDPH) hepatitis registry along with negative results obtained from two reference laboratories that run 85% of the city’s hepatitis tests. The aims of this study are 1) to assess differences in HCV positivity rates by patient demographics, neighborhood poverty, and ordering facility type, and 2) to measure the impact of the CDC’s September 2012 recommendation that all adults born between 1945 – 1965 (ie. ‘baby boomers’) receive screening for HCV.
METHODS: Negative HCV Ab testing data from January 1st, 2012 – June 30th, 2014 was obtained from Quest and Labcorp, and merged with HCV positive test results that were reported to PDPH during the same time period. Positivity rates, in total and stratified by demographics (age and gender), facility type, and neighborhood, were calculated using SAS. Rates by census tract were mapped using ArcGIS, and overlaid with 2012 American Community Survey data on race, ethnicity, income, and poverty rate.
RESULTS: During the study period, 132,738 individuals received an HCV Ab test, of whom 16,891(13%) tested positive. The number of tests reported per month increased from ~3200 before to ~3850 after the CDC baby boomer testing recommendation. HCV Ab positive were more often >=50 years of age (58%) and male (63%) than persons testing HCV Ab negative (32% and 35%, respectively). Individuals testing HCV Ab positive were also more likely to have been screened in a city health center than individuals who tested negative. Interestingly, regions of the city with the lowest poverty rates tended to have the highest rates of HCV positivity.
CONCLUSIONS: These results indicate that the CDC’s new baby boomer recommendation is helping to promote HCV screening in Philadelphia. Findings also show that particular populations are at greater risk of testing HCV positive, including males, individuals >=50 years of age, and people screened in a city health center. The negative association between poverty and HCV positivity may be related to the uptick in baby boomer testing and requires further investigation. Together, these data will inform patient outreach efforts and help PDPH to focus HCV testing resources in regions of Philadelphia that may require additional attention.