Background:
Emergency departments (EDs) are a strategic site for implementing screening strategies for Hepatitis C Virus (HCV) infection, allowing the identification of undiagnosed cases, particularly in vulnerable populations or those without access to other services such as primary care. However, missed diagnostic opportunities may delay treatment initiation and increase the health burden. The aim was to identify indicators of missed opportunities for diagnosis and treatment of active HCV infection in patients identified through an emergency screening programme.
Methods:
A retrospective analysis of patients diagnosed with active HCV infection through an ED opportunistic screening programme (FOCUS) was performed between August 2021 and September 2024. Clinical records were reviewed to identify previous contacts with the health care system and possible indicators of missed opportunities and other exposure factors or risk situations.
Results:
Of the 83 patients diagnosed with active HCV infection by screening, 92% had at least one previous contact with the healthcare system. Missed opportunities included elevated transaminases (56%), history of injecting or inhaling drug use (25%), coming from countries with high HCV prevalence (8%), and history of incarceration (7%). Other factors identified were severe mental disorders, co-infection with HIV and transfusions before 1990. In addition, 44% of patients were aware of their infection status but had not received treatment due to fear of side effects of old treatments, co-morbidities, incarceration or refusal of treatment.
Conclusion:
The results show significant gaps in the diagnosis and treatment of HCV prior to the implementation of screening in EDs, especially in patients with clear risk factors or suggestive clinical findings. The implementation of opportunistic screening through the FOCUS programme proved to be an important tool in detecting cases that would otherwise have remained undiagnosed. This evidence highlights the need for screening strategies at key points of care that could reduce underdiagnosis and complications associated with HCV.
Disclaimer: Gilead Sciences’ FOCUS Program funding supports screening & linkage to a first appointment after diagnosis regardless of how organizations handle subsequent patient care and treatment |