Hepatitis c virus screening and prevalence in US department of veterans affairs healthcare facilities

Background: Veterans in Department of Veterans Affairs (VA) care are known to be at increased risk of hepatitis C virus (HCV) infection. In 2012, the Centers for Disease Control and Prevention recommended one-time HCV screening for all persons born during 1945-1965 to reduce HCV-related morbidity and mortality. We sought to assess the extent to which VA healthcare facilities nationally have screened Veterans - particularly those born during 1945-1965 - for HCV and to assess variability in HCV infection prevalence across VA healthcare facilities.

Methods: We used the VA's Corporate Data Warehouse to identify the birth dates and VA laboratory tests from October 1, 1999 onward of all Veterans with at least one VA outpatient visit in 2011. We accepted HCV antibody, viral load and genotype tests performed on any date as evidence of HCV screening and detectable viral load or genotype results as evidence of HCV infection. We calculated HCV screening rates, supplementary HCV RNA testing rates, anti-HCV prevalence and HCV infection prevalence.

Results: Among 5,415,084 Veterans, median HCV screening rates from 130 reporting medical centers encompassing all VA healthcare facilities were 39.5% (range 13.1%-88.1%) for those born before 1945, 64.4% (range 33.4%-90.1%) for those born during 1945-1965 and 60.5% (range 30.5%-86.5%) for those born after 1965. In over 2.8 million Veterans screened, median anti-HCV prevalence across the 130 medical centers was 2.7% (range 0.6%-8.2%) for those born before 1945, 13.4% (range 5.4%-28.4%) for those born during 1945-1965 and 1.9% (range 0.6%-6.5%) for those born after 1965. Median HCV infection prevalence across the facilities was 1.5% (range 0.3%-5.9%) for those born before 1945, 10.2% (range 3.5%-23.3%) for those born during 1945-1965 and 1.2% (range 0.3%-4.7%) for those born after 1965.

Conclusions: Among Veterans in recent VA care, HCV screening rates were highest among those born during 1945-1965. The wide variation across VA healthcare facilities in HCV screening rates in the critical birth cohort reveals a target for practice improvement but also demonstrates that extremely high performance can be achieved. Anti-HCV and HCV infection prevalence was markedly elevated among those born during 1945-1965 compared to those born before or after this birth cohort. Prevalence of anti-HCV and HCV infection varied less across facilities than HCV screening rates. The lowest observed HCV infection prevalence of 3.5% in the 1945-1965 birth cohort was still higher than the estimated 2.4% prevalence in this birth cohort in the general US population.