HCV screening strategies in the United States

In 1998 the Centers for Disease Control and Prevention (CDC) published Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease recommending anti-HCV testing for populations “most likely to be infected with HCV” such as persons with a history of injection drug use, blood product exposure or HIV infection. However, risk-based strategies for HCV testing require assessments to determine which patients should be tested. Barriers to risk assessments include reluctance of providers to ask patients stigmatizing questions and patient reticence to disclose risk behaviors. CDC estimates 3.2 million Americans are HCV infected, and persons born from 1945 through 1964 are 4.6 times more likely to be anti-HCV+ than persons born outside that cohort. Studies suggest that 50-70% of anti-HCV+ persons are unaware of their status, indicating they would be unlikely to be referred for potentially life-saving treatment or unlikely to receive secondary prevention messages to decrease or eliminate alcohol and other drug use.

To assess the effectiveness of current HCV screening practices and lay the scientific foundation for updating CDC's recommendations, retrospective and prospective evaluations are being conducted in managed and primary care settings. These studies have found a wide variance in prevalence of documented risk factors (e.g., HIV ranging from 0.3-4.5%), proportions of persons being tested (4.3-39.7%), and prevalence of HCV (0.2-4.6%). This presentation will discuss these studies and their findings, and outline CDC's efforts to evaluate a birth-cohort based approach to routine one-time screening of all persons born from 1945 through 1964.