Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts

• Published in: PloS one Vol. 9; no. 7; p. e102766
• Main Authors: Yehia, Baligh R, Herati, Ramin S, Fleishman, John A, Gallant, Joel E, Agwu, Allison L, Berry, Stephen A, Korthuis, P Todd, Moore, Richard D, Metlay, Joshua P, Gebo, Kelly A
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.07.2014; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Adults; AIDS; Biology and life sciences; Clinics; Confidence intervals; Disease transmission; Drug abuse; Drug therapy; Ethnicity; Female; Government programs; Guidelines; Health care; Health Services Needs and Demand; Hepacivirus - immunology; Hepatitis; Hepatitis C; Hepatitis C - immunology; Hepatitis C - virology; Hepatitis C Antibodies - immunology; Hepatitis C virus; Hispanic people; HIV; HIV Infections - immunology; HIV Infections - virology; Human immunodeficiency virus; Humans; Identification methods; Infections; Information technology; Logistic Models; Male; Mass Screening - methods; Medicaid; Medical informatics; Medical screening; Medicine; Medicine and health sciences; Mens health; Middle Aged; Patients; Primary care; Risk; Risk Factors; Sexually transmitted diseases; Statistical analysis; STD; Substance Abuse, Intravenous - immunology; Substance Abuse, Intravenous - virology; Uninsured people; Viruses; Young Adult; Oregon; United States > US; Maryland; Massachusetts; Baltimore Maryland; Pennsylvania
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0102766

Guidelines recommend hepatitis C virus (HCV) screening for all people living with HIV (PLWH). Understanding HCV testing practices may improve compliance with guidelines and can help identify areas for future intervention. We evaluated HCV screening and unnecessary repeat HCV testing in 8,590 PLWH initiating care at 12 U.S. HIV clinics between 2006 and 2010, with follow-up through 2011. Multivariable logistic regression examined the association between patient factors and the outcomes: HCV screening (≥1 HCV antibody tests during the study period) and unnecessary repeat HCV testing (≥1 HCV antibody tests in patients with a prior positive test result). Overall, 82% of patients were screened for HCV, 18% of those screened were HCV antibody-positive, and 40% of HCV antibody-positive patients had unnecessary repeat HCV testing. The likelihood of being screened for HCV increased as the number of outpatient visits rose (adjusted odds ratio 1.02, 95% confidence interval 1.01-1.03). Compared to men who have sex with men (MSM), patients with injection drug use (IDU) were less likely to be screened for HCV (0.63, 0.52-0.78); while individuals with Medicaid were more likely to be screened than those with private insurance (1.30, 1.04-1.62). Patients with heterosexual (1.78, 1.20-2.65) and IDU (1.58, 1.06-2.34) risk compared to MSM, and those with higher numbers of outpatient (1.03, 1.01-1.04) and inpatient (1.09, 1.01-1.19) visits were at greatest risk of unnecessary HCV testing. Additional efforts to improve compliance with HCV testing guidelines are needed. Leveraging health information technology may increase HCV screening and reduce unnecessary testing.