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
Research background

Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease worldwide. In the last few years, new treatments for HCV have revolutionized management of this infection.

Research motivation

A major obstacle to viral elimination is identifying asymptomatic infected patients. Most screening strategies focus on high-risk patients, while others target the general population. Prior studies showed that HCV prevalence in emergency department attendees is higher than the general population.

Research objectives

A single center prospective study, aimed at identifying undiagnosed HCV carriers among high risk emergency room attendees and linking them to anti-viral treatment.

Research methods

Persons visiting the emergency department were screened by a 9-question risk factor-specific questionnaire. Those with at least one risk factor were tested for HCV with blood and saliva antibody tests.

Research results

Five hundred and forty-one participants were tested for HCV. Eighty five percent of participants underwent saliva testing, 34% were tested for serum antibodies, and 25% had both tests. 17 patients (3.1%) had a positive result, compared to local population incidence of 1.96%. Eighty two percent of patients with positive HCV were people who inject drugs, and 64% served time in prison. Twelve patients were found to have been previously diagnosed with HCV but were unaware of the diagnosis. At 1-year follow-up, only one patient completed HCV-RNA testing and was found negative. None of the remaining patients completed the recommended testing, visited a hepatology clinic or received anti-viral treatment.

Research conclusions

Targeted high-risk screening in the emergency department identified undiagnosed and untreated HCV carriers, but did not improve treatment rates.

Research perspectives

This study suggests that in order to achieve viral elimination, other avenues need to be explored to find a framework that will enable treatment completion for this population.