Lue Nicole, Lom Jennifer, Manguso Elizabeth, Park Brandi, Palacio Andres, Darby Rapheisha, Shah Bijal, Yaffee Anna, Miller Lesley
Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA.
Division of General Internal Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA.
Am J Emerg Med. 2025 Aug;94:133-139. doi: 10.1016/j.ajem.2025.04.046. Epub 2025 Apr 21.
In 2020, the CDC expanded hepatitis C (HCV) screening recommendations to include universal screening for persons 18 and older. We implemented universal screening in the emergency department (ED) within a safety-net health system. We aimed to measure HCV prevalence and linkage to care (LTC) outcomes in the ED and compare them to the outpatient clinics within the same health system.
Patients aged 18-79 without HCV qualified for screening. We measured prevalence of both anti-HCV+ (exposure) and HCV RNA+ (active infection). Those with active HCV were flagged for LTC and their charts were followed for outcomes. HCV prevalence and LTC in the ED were compared to those in outpatient clinics over the same time.
9511 patients were screened for HCV from 2019 to 2022 in the ED. 6.9 % (659) were anti-HCV+. 54.9 % (320 of 582) of anti-HCV+ individuals or 3.4 % of those screened (320 of 9511) were HCV RNA+. The LTC rate was 24.1 % (77 of 320) and a total of 56 individuals (17.8 % of all HCV RNA+ ED patients, 72.7 % of those linked) initiated treatment. HCV prevalence was higher in the ED compared to the outpatient clinic setting. Demographics and LTC rates also significantly differed between these two cohorts.
We identified a higher HCV prevalence in the ED relative to the outpatient clinic setting and significant need for improvement in LTC and HCV treatment initiation. Our findings suggest universal screening is an important tool to diagnose HCV infections but may require novel strategies for improved LTC and treatment initiation.
2020年，美国疾病控制与预防中心（CDC）扩大了丙型肝炎（HCV）筛查建议，将18岁及以上人群的普遍筛查纳入其中。我们在一个安全网医疗系统的急诊科（ED）实施了普遍筛查。我们旨在测量急诊科丙型肝炎病毒的流行率以及与护理的联系（LTC）结果，并将其与同一医疗系统内的门诊诊所进行比较。
年龄在18 - 79岁且无丙型肝炎病毒的患者符合筛查条件。我们测量了抗HCV +（接触）和HCV RNA +（活动性感染）的流行率。那些患有活动性丙型肝炎病毒的患者被标记为接受长期护理，并跟踪他们的病历以获取结果。将急诊科的丙型肝炎病毒流行率和长期护理情况与同期门诊诊所的情况进行比较。
2019年至2022年期间，急诊科对9511名患者进行了丙型肝炎病毒筛查。6.9%（659名）为抗HCV +。抗HCV +个体中有54.9%（582名中的320名）或筛查人群的3.4%（9511名中的320名）为HCV RNA +。长期护理率为24.1%（320名中的77名），共有56人（占所有HCV RNA +急诊科患者的17.8%，占接受长期护理患者的72.7%）开始治疗。与门诊诊所相比，急诊科的丙型肝炎病毒流行率更高。这两个队列的人口统计学特征和长期护理率也存在显著差异。
我们发现急诊科的丙型肝炎病毒流行率高于门诊诊所，并且在长期护理和丙型肝炎病毒治疗启动方面有显著的改进需求。我们的研究结果表明，普遍筛查是诊断丙型肝炎病毒感染的重要工具，但可能需要新的策略来改善长期护理和治疗启动。
