Centers for Disease Control and Prevention Recommendations for Hepatitis C Testing: The Need to Adapt Universal Screening in an Appalachian Emergency Department
Centers for Disease Control and Prevention Recommendations for Hepatitis C Testing: The Need to Adapt Universal Screening in an Appalachian Emergency Department
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DOI：
10.1111/acem.13932
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发表时间：
2020-02-28
影响因子：
4.4
通讯作者：
Burrell, Carmen N.
中科院分区：
文献类型：
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作者：
Wojcik, Elena M.;Sharon, Melinda J.;Burrell, Carmen N.
背景疾病控制和预防中心建议对婴儿潮一代和高危患者进行丙型肝炎病毒 (HCV) 筛查；然而，HCV 的发病率在年轻人群中迅速增加，并且筛查受到护理和危险因素评估的限制。本研究的目的是评估阿巴拉契亚急诊室（ED）通过两种筛查模式识别出的 HCV 抗体阳性（Ab+）和核糖核酸（RNA）确诊阳性患者的特征。方法这是对 2018 年 1 月 1 日至 10 月 31 日在 ED 筛查 HCV Ab+ 的患者进行的回顾性队列研究。提取数据，并对基于风险的筛查模型和通用筛查模型进行比较分析。结果总体而言，444 名患者筛查了 HCV Ab+，中位年龄为 39 岁。从 2018 年 1 月到 5 月，危险因素模型在 3,014 名筛查的患者中识别出 126 名 HCV Ab+ 患者 (4%)，而从 2018 年 6 月到 10 月，通用模型从 5,407 名筛查的患者中识别出 318 名 HCV Ab+ 患者 (6%；p < 0.001)。始终有很大比例的新诊断（71%）。在危险因素模型 (76, 60%) 和通用模型 (186, 58%) 时间段内，RNA 确认阳性患者之间没有显着下降 (p = 0.72)。这些模型报告的静脉药物使用率很高，而普遍筛查采用率较低，仅为 33%。 结论 这项研究首次展示了阿巴拉契亚急诊室向普遍筛查模型过渡期间发现的 HCV Ab+ 和 RNA 确诊阳性患者的特征。无论筛查模型如何，大多数诊断都是新的，但在通用模型下，更多的患者筛查出 HCV Ab+，并且类似比例的 RNA 确诊阳性。鉴于普遍筛查的采用率较低，并且风险因素仍然相似，未来的研究应该调查如何更有效地在更广泛的范围内实施普遍筛查模型以识别早期感染。
Background The Centers for Disease Control and Prevention recommends screening baby boomers and high-risk patients for hepatitis C virus (HCV); however, the incidence of HCV is rapidly increasing among younger populations, and screening is limited by access to care and risk factor assessment. The purpose of this study was to evaluate characteristics of HCV antibody-positive (Ab+) and ribonucleic acid (RNA)-confirmed-positive patients identified via two screening models in an Appalachian emergency department (ED).Methods This was a retrospective cohort study of patients who screened HCV Ab+ in the ED from January 1 to October 31, 2018. Data were extracted, and comparative analyses were conducted between the risk-based and the universal screening models.Results Overall, 444 patients screened HCV Ab+, with a median age of 39 years. From January to May 2018, the risk factor model identified 126 HCV Ab+ patients out of 3,014 screened (4%), whereas from June to October 2018, the universal model identified 318 HCV Ab+ patients out of 5,407 screened (6%; p < 0.001). A consistently large proportion of diagnoses were new (71%). There was no statistically significant decrease between the RNA-confirmed-positive patients during the risk factor model (76, 60%) and universal model (186, 58%) time periods (p = 0.72). The models had high rates of reported intravenous drug use, and the universal screening adoption was modest at 33%.Conclusion This study was the first to present characteristics of HCV Ab+ and RNA-confirmed-positive patients identified during the transition to a universal screening model in an Appalachian ED. Most diagnoses were new regardless of screening model, but more patients screened HCV Ab+, and a similar proportion were RNA-confirmed-positive, under the universal model. Given that adoption of universal screening was modest, and risk factors remained similar, future research should investigate how to more effectively implement a universal screening model on a wider scale to identify early infections.