Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2020; 26(32): 4878-4888
Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4878
Emergency department targeted screening for hepatitis C does not improve linkage to care
Inbal Houri, Noya Horowitz, Helena Katchman, Yael Weksler, Ofer Miller, Liat Deutsch, Oren Shibolet
Inbal Houri, Noya Horowitz, Helena Katchman, Yael Weksler, Ofer Miller, Liat Deutsch, Oren Shibolet, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
Inbal Houri, Helena Katchman, Yael Weksler, Ofer Miller, Liat Deutsch, Oren Shibolet, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
Author contributions: Shibolet O, Horowitz N and Katchman H designed the research; Weksler Y and Miller O performed the research; Houri I and Deutsch L analyzed the data; Houri I and Shibolet O wrote the paper; Houri I, Katchman H, Deutsch L and Shibolet O critically reviewed the manuscript.
Supported by an Educational Grant from AbbVie Inc. Israel.
Institutional review board statement: The study was reviewed and approved by the Tel-Aviv Medical Center institutional review board (IRB) (0634-16). All study participants screened provided informed consent prior to study enrollment.
Informed consent statement: The informed consent to the study was provided.
Conflict-of-interest statement: O.S received consultation fees from Abbvie Inc. Israel but not associated to this project. The other authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Oren Shibolet, MD, Professor, Director, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Weizmann 6, Tel-Aviv 6423906, Israel.
Received: May 20, 2020
Peer-review started: May 20, 2020
First decision: June 4, 2020
Revised: June 13, 2020
Accepted: August 9, 2020
Article in press: August 9, 2020
Published online: August 28, 2020

Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease worldwide. New treatments for HCV revolutionized management and prompted the world health organization to set the goal of viral elimination by 2030. These developments strengthen the need for HCV screening in order to identify asymptomatic carriers prior to development of chronic liver disease and its complications. Different screening strategies have been attempted, most targeting high-risk populations. Previous studies focusing on patients arriving at emergency departments showed a higher prevalence of HCV compared to the general population.


To identify previously undiagnosed HCV carriers among high risk emergency room attendees and link them to care for anti-viral treatment.


In this single center prospective study, persons visiting the emergency department in an urban hospital were screened by a risk factor-specific questionnaire. The risk factors screened for were exposure to blood products or organ transplantation before 1992; origins from countries with high prevalence of HCV; intravenous drug use; human immunodeficiency virus carriers; men who have sex with men; those born to HCV-infected mothers; prior prison time; and chronic kidney disease. Those with at least one risk factor were tested for HCV by serum for HCV antibodies, a novel oral test from saliva (OraQuick®) or both.


Five hundred and forty-one participants had at least one risk factor and were tested for HCV. Eighty four percent of all study participants had only one risk factor. Eighty five percent of participants underwent OraQuick® testing, 34% were tested for serum anti-HCV antibodies, and 25% had both tests. 3.1% of patients (17/541) had a positive result, compared to local population incidence of 1.96%. Of these, 82% were people who inject drugs (current or former), and 64% served time in prison. One patient had a negative HCV-RNA, and two patients died from non-HCV related reasons. On review of past medical records, 12 patients were found to have been previously diagnosed with HCV but were unaware of their carrier state. At 1-year follow-up none of the remaining 14 patients had completed HCV-RNA testing, visited a hepatology clinic or received anti-viral treatment.


Targeted high-risk screening in the emergency department identified undiagnosed and untreated HCV carriers, but did not improve treatment rates. Other strategies need to be developed to improve linkage to care in high risk populations.

Keywords: Screening, Emergency departments, Israel, Saliva, Hepatitis C, Liver

Core tip: Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease. We attempted to identify previously undiagnosed HCV infected patients by screening high-risk populations arriving in the emergency department and link them to care. Although we identified infected persons at a higher rate than the Israeli population prevalence, none have started treatment despite multiple efforts.