BACKGROUND: One-time screening for hepatitis c virus (HCV) antibody (Ab) is now recommended for all persons in the high risk birth cohort (born from 1945-1965). The HCV Test and Cure project (HCV-TAC) at Public Health – Seattle & King County (PHSKC) has partnered with six local healthcare organizations (HCO) to increase screening among their birth cohort patient population. Each HCO implemented their own strategy to increase screening, and provided data on patients that screened HCV Ab positive, HCV Ab negative, and those who have not been screened for HCV Ab.
METHODS: Partner HCOs provided data on HCV lab tests and clinic visits from 9/30/2013-9/30/2016; the first year is the baseline period. Clinic visits within each study year were examined for each HCO to determine birth cohort screening progress. HCV screening is measured as the proportion of all birth cohort patients with at least one visit to a primary care clinic in the time period that has been tested for HCV Ab. The total number of HCV Ab tests performed on birth cohort patients was also analyzed for significant increases over the baseline period. Percentages of patients testing positive for HCV Ab are also reported. Statistical significance was determined using Chi-square and t-tests.
RESULTS: Partner HCOs implemented various strategies to increase birth cohort screening, including EMR prompt, training medical assistants to automatically order HCV Ab tests, sending annual reminder letters to patients, and educating primary care providers. During the baseline period, 18% (28,750/159,695) of birth cohort patients with visits to a primary care clinic had been screened for HCV. By the end of Year 2, 35% (59,515/171,821) had been screened for HCV, a significant increase over baseline (p<0.0001). Volume of HCV Ab tests performed on birth cohort patients increased from an average of 2,430 Ab tests per quarter to 9,401 tests per quarter in Year 2 (p<0.0001). As the volume of Ab tests increased, the percentage testing HCV Ab positive decreased from 7% in baseline to 2% in Year 2.
CONCLUSIONS: All HCV-TAC partner sites significantly increased the percentage of their birth cohort population that has been screened for HCV Ab and the total number of HCV Ab tests compared to the baseline period. As sites transition from risk-based screening to birth cohort-based screening, the proportion of HCV Ab positive results has decreased. The HCO that implemented an EMR prompt observed the greatest increase in birth cohort screening.