Is Birth Cohort Screening Effective for Identifying HCV Cases?

Summary and Comment |
October 6, 2017

Is Birth Cohort Screening Effective for Identifying HCV Cases?

  1. Atif Zaman, MD, MPH

Yes; in three randomized trials, birth cohort screening was three to eight times more effective than risk-based screening.

  1. Atif Zaman, MD, MPH

Although we have highly effective therapies for the treatment of chronic hepatitis C virus (HCV) infection, case identification is critical so that patients can be linked to care. Although one-time HCV testing for individuals born between 1945 and 1965, or birth cohort screening, has been recommended in the U.S., effectiveness data are sparse.

In three randomized, controlled trials, researchers assessed the probability of identifying undiagnosed HCV infection using a birth cohort screening method (three different methods at three different academic centers) compared with usual care. Patients without a previous history of HCV testing received a one-time screening offer via repeated mailings, direct patient solicitation by trained recruiters directly following a primary care clinic visit, or an electronic health record (EHR)–integrated best-practice alert prompt at the time of a clinic visit.

In all three trials — the repeated mailings trial (approximately 9000 patients), the patient solicitation trial (approx. 8900), and the EHR best-practice alert trial (approx. 15,000), the interventions were eight, five, and three times more effective, respectively, at identifying HCV cases compared with usual care.

Comment

These findings clearly demonstrate that birth cohort screening is superior to usual risk-based methods for identifying patients with HCV infection. A next reasonable research step would be to directly compare implementation costs of these different screening approaches to determine which method is most cost effective to implement in the primary care setting.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Grant/Research support: Merck

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