Birth Cohort Testing for Hepatitis C Virus — Indian Health Service 2012–2015

Abstract

Hepatitis C virus (HCV) infection is a substantial and largely unrecognized public health problem. An estimated 3.5 million persons in the United States are currently living with HCV infection, at least half of whom are unaware of their infection (1-3). Persons born during 1945-1965 (the "baby boomer" birth cohort) have a sixfold higher prevalence (2.6%) than adults of other ages, and represent 81% of all persons chronically infected with HCV (4). Therefore, in addition to recommending testing for all persons at risk for HCV infection, CDC and the U.S. Preventive Services Task Force (USPSTF) recommend one-time HCV testing for the birth cohort (5,6). Compared with the national average, American Indian/Alaska Native (AI/AN) persons have approximately twofold the rate of acute HCV incidence and HCV associated mortality (2). In June 2012, the Indian Health Service (IHS) implemented HCV testing in the 1945-1965 birth cohort and created a nationally standardized performance measure to monitor implementation of the recommendation. As of June 2015, the proportion of the birth cohort screened for HCV increased from a baseline of 7.9% (14,402/182,503) to 32.5% (68,514/211,014) among the AI/AN population served by IHS nationwide; provider training and the use of clinical decision tools were associated with increases in HCV testing. With this fourfold increase in testing in just 3 years, IHS needs to prepare for the challenges associated with increased identification of persons living with HCV infection.

Prevalence of hepatitis B and C infection in persons living with HIV enrolled in care in Rwanda

“…Our findings indicate that one-time screening of individuals aged over 55 should be recommended. Birth-cohort screening is in practice or has been evaluated in various other settings and has largely been identified as a cost-effective initiative [26–29]. …”

Race and Hepatitis C Care Continuum in an Underserved Birth Cohort

“…Hepatitis C virus (HCV) infection affects over 3.5 million Americans and untreated HCV is associated with increased mortality, loss of productivity, and healthcare costs, 1,2 whereas HCV viral eradication with treatment improves health. [3][4][5] Adult patients in the 1945-1965 birth cohort account for nearly 75% of HCV cases in the USA 6,7 and are at increased risk of mortality and hepatocellular carcinoma. 6,8 Consequently, in 2012 and 2013, the Centers for Disease Control and the U.S. Preventive Services Task Force recommended one-time birth cohort HCV screening irrespective of risk factors to improve identification of chronic HCV cases.…”

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing

“…The current test uptake of 51% was higher compared with international studies targeted to risk factors (10% to 49%) and other Dutch studies with a personal invitation (18% to 42%). [29][30][31][32][33][34][35][36] The family physicians' personal invitation appeared key for achieving this high uptake, as confirmed by the reported main reason to get tested. Test uptake in specific settings, such as the emergency department, may be even higher (up to 65%), 37 as here tests can be offered and performed within the routine diagnostic work-up.…”

“…A priori, we expected a test uptake of 40% based on international targeted-testing studies and Dutch studies using personal letter invitations. [29][30][31][32][33][34] A positive anti-HCV test rate higher than the estimated Dutch prevalence of 0.1%-0.4% would be considered promising to explore further assessment and implementation of the testing strategy. [23][24][25] Test uptake and rates of positive test results were calculated among the patients invited and participants, and associated determinants were assessed using multivariate logistic regression analyses; determinants included hotspot, sex, age, educational level, and hepatitis exposure risk factors as non-Western migrant, surgery abroad, blood transfusion or organ transplant before 1992, HIV positive, or a history of intravenous drug use.…”