HCV Testing Remains Low Among High-Risk Population

A study published in American Journal of Preventive Medicine on March 8, 2017, examines hepatitis C (HCV) testing rates among individuals born between 1945 and 1965, often referred to as “baby boomers.”

In 2013, the US Preventive Services Task Force (USPSTF) advised all baby boomers to be tested for HCV. Although testing prevalence increased by 2015, the rate is still lower than officials would like it to be.

There are approximately 3.5 million people infected with HCV in the United States. Of these, 80% are baby boomers. Unfortunately, most individuals living with HCV are not aware of their infection status, and so the USPSTF recommendation is meant to increase HCV diagnosis in those populations. In addition, increased diagnosis would lower the risk of HCV infections developing into serious liver disease, such as cirrhosis or hepatocellular carcinoma.

While there was some progress in HCV diagnosis rates, study authors Ahmedin Jemal, DVM, PhD, and Stacey A. Fedewa, PhD, of Surveillance and Health Services Research of the American Cancer Society in Atlanta, Georgia, found that it was minimal.

The study cohort included 23,967 baby boomers, on whom data was collected between 2013 and 2015 form the National Interview Survey. Of these, only 21,827 study participants had complete records, including self-reported HCV blood testing.

Although small, there was a statistically significant increase in HCV testing two years after the USPSTF recommendation was implemented—12.3% to 13.8% (P = 0.013). Nevertheless, only 10.5 million of the 76.2 million baby boomers in the United States in 2015 were tested.

“Reasons for the overall slow uptake of testing may include barriers to preventive care; unapparent symptoms; lack of awareness of the need to be tested among patients, who may not be fully covered by insurers; and lack of physician awareness of the USPSTF recommendations,” the researchers detailed.

The study found that men were more likely to be tested than women (prevalence ratio (PR): 1.25, 95% confidence ratio: 1.08, 1.44). In addition, those who had lived with individuals known to have HCV infections were also more likely to get tested than those who did not share that experience (PR: 2.44, 95% CI: 2.01, 2.96).

Furthermore, those with just a high school diploma or less education had a lower testing rate than those who were college graduates (PR: 0.63, 95% CI: 0.48, 0.82 vs. PR: 0.58, 95% CI: 0.48, 0.72).

Additionally, insurance type appeared to play an important role in predicting whether or not a baby boomer had been tested for HCV. Higher screening was found in those with Medicare plus Medicaid (PR: 1.83, 95% CI: 1.32, 2.53), just Medicaid (PR: 1.35, 95% CI: 1.04, 1.76), and military insurance (PR: 1.62, 95% CI: 1.16, 2.26), relative to privately insured adults. The researchers explained that the higher testing rate in people with military insurance could be credited to the ongoing efforts of the Veterans Health Administration, since veterans have a high prevalence of HCV.

The team noted that their findings showed a substantially lower rate of HCV diagnoses than those of other studies. In one study, 90% of patients at a safety net clinic had been tested for HCV. In another study conducted at a New York community hospital, screening increased from 47% to 88%. The lower testing results in the recent study could be due to underreporting of testing. Furthermore, this study was population-based while the others were institution-based.

Despite the increase in HCV-testing following the USPSTF recommendation, there seems to be an overwhelming need to get baby boomers into doctors’ offices.

“These findings underscore the need for increased awareness for hepatitis C testing among healthcare providers and baby boomers and other innovative strategies such as state-mandated hepatitis C testing,” the researchers concluded.

The USPSTF recommendation follows that of the Centers for Disease Control and Prevention which urges baby boomers to get tested. As a cause of several liver complications, it is important to work towards not only diagnosing HCV infection, but curing it as well. A recent initiative out of Egypt hopes to eradicate HCV infection from around the world by offering low-cost treatment to the programs’ participants; this is in alignment with the World Health Organization’s goal of eradicating HCV by 2030.