Validation of a Hepatitis C Screening Tool in Primary Care

Abstract

Background: Although hepatitis C virus (HCV) has an estimated national prevalence of 1.8%, testing rates are lower than those recommended by guidelines, particularly in primary care. A critical step is the ability to identify patients at increased risk who should be screened. We sought to prospectively derive and validate a clinical predication tool to assist primary care providers in identifying patients who should be tested for HCV antibodies. Methods: A total of 1000 randomly selected patients attending an inner-city primary care clinic filled out a 27item questionnaire assessing 5 HCV risk factor domains: work, medical, exposure, personal care, and social history. Afterward, the patients underwent HCV antibody testing. Multivariable logistic regression analysis was performed to identify risk factors associated with HCV antibodies. Results: There was an 8.3% (95% confidence interval, 6.7%-10.2%) prevalence of HCV antibodies. The patients who were HCV antibody positive were more likely to be male, older, and insured by Medicaid (PՅ.02). Those who had risk factors within the medical, exposure, and social history domains were more likely to be HCV antibody positive. The area under the receiver operating characteristic curve for the screening tool based on these 3 domains was 0.77. With an increasing number of positive domains, there was a higher likelihood of HCV antibody positivity. Only 2% of patients with 0 risk factors had HCV antibodies. Conclusions: A prediction tool can be used to accurately identify patients at high risk of HCV who may benefit from serologic screening. Future studies should assess whether wider use of this tool may lead to improved outcomes.

Validation of EGCRISC for Chronic Hepatitis C Infection Screening and Risk Assessment in the Egyptian Population

“…Furthermore, the use of a proportionally allocated population based sample asserts that the derived results feature the Egyptian population. The study conducted by McGinn et al, in USA was limited by surveying population coming from an inner-city primary care practice, thus the results do not represent the true community [21]. Other studies validated their tool on hospital based small samples [19, 22] or on certain risk groups [5, 20].…”

Developing and validating a scoring tool for identifying people who inject drugs at increased risk of hepatitis C virus infection

“…Worldwide, infection with hepatitis C virus (HCV) is common among people who inject drugs (PWID) 1. Estimates suggest that >70% of new cases of HCV infection are associated with injecting drug use 2 3.…”

PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation

“…133 One blood donor study associated HCV with older mean age 130 while the other did not. 131 In general population studies, HCV was associated with increased mean age 141 and decade of birth (with people born from 1940 to 1959 having the highest prevalence), 132 but not age ,50 years 120 or age ,60 years. 123 c. Race/ethnicity and national origin.…”

“…132,141 Among blood donors, one study found that Hispanic ethnicity led to a higher risk of HCV than white race in a multivariate analysis, 140 but another study did not come to this conclusion. 133 Being Asian vs. white was associated with having a lower prevalence of HCV among blood donors in a multivariate analysis.…”