There is room for improvement in screening and treatment for hepatitis C virus (HCV) infection in at-risk youths ages 13 to 21, according to a large study of U.S. federally qualified health centers published as a research letter in the Journal of the American Medical Association on December 10.
Dr. Rachel Epstein, an infectious disease specialist at Boston University, and colleagues evaluated electronic health records for 269,124 young people who had one or more visits to a federally qualified health center affiliated with the Oregon Community Health Information Network between 2012 and 2017. The subjects also had no prior diagnosis of HCV. Records were drawn from centers operating in 19 U.S. states.
The focus of the study was to determine the extent to which youths who use drugs -- and are therefore at high risk for HCV -- were tested and treated.
In the overall population, 2.5% underwent HCV testing, and of these, 1.8% had a positive result for anti-HCV antibodies. Out of 2,573 with documented use of opioids, amphetamine, or cocaine, 29.6% were tested for anti-HCV antibodies and 7.1% were positive (JAMA, December 10, 2019, Vol. 322:22, pp. 2245-2247).
Screening for anti-HCV antibodies should be followed up with polymerase chain reaction (PCR) testing for HCV RNA. In the study, 75% of the positive HCV antibody test results were followed up with RNA testing, which showed that 44.6% had detectable RNA, meaning they had a current infection. Only one youth was documented to have gone on to get HCV treatment.
Epstein and colleagues noted that federally qualified health centers are an "important [healthcare] source for underserved communities." The results suggest program design and policy improvements are needed to address low HCV testing and treatment rates in youths with documented drug use, they added.
The authors acknowledged that a limitation of the study is that subjects might have been tested for HCV and/or treated outside the setting of the federally qualified health centers, so the interactions may have been missed in the health records studied. However, this isn't enough to explain the low observed screening and treatment rates, they noted.
"Early identification of HCV is critical to cure current infections, prevent transmission and morbidity from disease progression, and eliminate HCV, particularly with effective treatments now approved in 12- to 17-year-olds," Epstein and colleagues wrote.
HCV was once viewed as a disease that primarily afflicts baby boomers, but the rise of injectable drug use has put younger people at risk of infection; in recent years, the biggest increase was seen in those younger than 40. The U.S. Centers for Disease Control and Prevention (CDC) recommends one-time testing for adults born from 1945 to 1965, in addition to HCV testing for people who currently inject drugs or have ever injected drugs -- even once or twice.
In August, the U.S. Preventive Services Task Force (USPSTF) published a draft of revised recommendations for HCV screening that greatly expanded the pool of people who should be tested. The USPSTF advised that all adults between the ages of 18 and 79 should be screened, and that it should be considered for people younger than 18 and older than 79 who are at high risk for infection.