Who Needs Hepatitis C Screening

Are Test Results Accurate

Although no test is perfect, hepatitis C testing is an important and accepted method of testing for HCV. In order to reduce the risk of inaccurate results, doctors take steps to verify a patients diagnosis. For example, a positive test result for hepatitis C antibody requires confirmation with HCV RNA testing.

Why Test All Your Adult Patients

• New cases of hepatitis C are on the rise, particularly among reproductive age adults. Rates of new HCV infections increased by more than 60% from 2015 to 2019. And in 2019, more than 63% of HCV infections occurred among adults 20-39 years of age.
• Your patients arent aware of their risk. Almost half of people with hepatitis C are unaware of their infection. Testing is the first step to accessing curative treatment. Without treatment, approximately 15-20% of adults with chronic HCV infection will develop progressive liver fibrosis and cirrhosis.
• Hepatitis C can be cured. Over 90 percent of people infected with HCV can be cured with 8-12 weeks of oral therapy. Treatment of hepatitis C is associated with reductions in mortality among persons with chronic hepatitis C.

Drawbacks To Screening For Hepatitis C

A patient’s worry or anxiety while waiting for test results, concerns about insurance coverage of evaluation and treatment, adverse effects of treatment, and complications associated with liver biopsy can limit screening for hepatitis C. However, the accuracy of HCV RNA testing, the availability of medication assistance programs for uninsured patients, and improved treatments with fewer side effects and shorter duration should allay some of the anxiety associated with the screening process.

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Effective Treatments Are Available For Hepatitis C

New medication to treat for HCV have been approved in recent years. These treatments are much better than the previously available treatment because they have few side effects and do not need to be injected. There are several direct-acting antiviral HCV treatments that cure more than 95% of people who take them in 8 to 12 weeks. HCV treatment dramatically reduces deaths among people with HCV infection, and people who are cured of HCV are much less likely to develop cirrhosis or liver cancer.

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How Many People Have Hepatitis C

During 2013-2016 it was estimated that about two and half million people were chronically infected with HCV in the United States. The actual number may be as low as 2.0 million or as high as 2.8 million.Globally, hepatitis C is a common blood-borne infection with an estimated 71 million people chronically infected according to the World Health Organization .

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Getting Tested For Hepatitis C

A blood test, called an HCV antibody test, is used to find out if someone has ever been infected with the hepatitis C virus. The HCV antibody test, sometimes called the anti-HCV test, looks for antibodies to the hepatitis C virus in blood. Antibodies are chemicals released into the bloodstream when someone gets infected.

Test results can take anywhere from a few days to a few weeks to come back. Rapid anti-HCV tests are available in some health clinics and the results of these tests are available in 20 to 30 minutes.

Take An Active Approach To Testing

Testing for HCV: the diagnosis of HCV infection requires 2 tests.

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Why Is It Important To Test Persons Born Between 1945 And 1965

• According to the Centers for Disease Control and Prevention , more than 75% of adults infected with hepatitis C are people born from 1945 through 1965 .
• The reason that baby boomers have high rates of hepatitis C is not completely understood. However, it is believed that most baby boomers became infected in the 1970’s and 1980’s when rates of hepatitis C and drug use were highest. Since people with hepatitis C can live for decades without symptoms, many baby boomers are unknowingly living with an infection they got many years ago that can lead to liver disease, liver failure and cancer.
• Hepatitis C is primarily spread through contact with blood from an infected person. Many baby boomers could have gotten infected from contaminated blood and blood products before widespread screening of the blood supply began in 1992 and universal precautions were adopted. Still, many baby boomers do not know or remember how or when they were infected.

How Much Does The Test Cost

The cost of hepatitis C testing depends on the tests that are performed, where the test is conducted, and a patients health insurance coverage. When testing is ordered by a doctor, patients with health insurance may find it helpful to discuss the cost of hepatitis C testing with their insurance company. In addition to the cost of testing, there may be other out-of-pocket costs such as copays and deductibles.

For patients without health insurance, or for whom insurance doesnt cover the cost of testing, it may be helpful to discuss the cost of hepatitis C testing with a doctor or hospital administrator.

At-home hepatitis C testing starts around $49. Some at-home kits test for multiple types of viral hepatitis at once, with the cost of these panels starting around $80.

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How Is It Spread

Hep C is usually spread when someone comes into contact with blood from infected person. This can happen through sharing IV needles, razors, toothbrushes, and intranasal equipment with an infected person. Also common in people who have received unprofessional tattoos, blood transfusion prior to 1992, and who have received dental work prior to cleaning guidelines.

Assessment Of Magnitude Of Net Benefit

The USPSTF concludes with moderate certainty that screening for HCV infection in adults aged 18 to 79 years has substantial net benefit.

See Table 1 and Table 2 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine net benefit, see the USPSTF Procedure Manual.8

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Educating Clients About Viral Hepatitis

Clients may believe they know about viral , but their understanding of the disease may not be accurate. It is easy to confuse the three main types of viral , B, and C. Clients may have formed impressions based on limited or incorrect information. Counselors should briefly describe hepatitis A, B, and C, including their prevalence, , and relationship to drug use, as well as to other infections, such as HIV and sexually transmitted diseases. Specific strategies for speaking with clients include:

• Speak clearly and keep the message simple, focused, and brief.
• Use language, examples, and concepts that the client understands.
• Use appropriate visual aids.
• Frame numerical statements in terms that are easy to visualize. Say 5 out of 100 people rather than 5 percent of the population say more than half instead of the majority.
• Repeat the information at different times in different ways. The average client retains only approximately one-third of what he or she is told. Summarize essential points.
• Pay attention to a clients response to the information. For example, if a client stiffens his or her posture, consider saying, I notice that this topic seems to make you uncomfortable. It does for a lot of people. Please tell me what youre feeling right now. Id really like to help you with this.
• Use the opportunity to describe the potential detrimental effects of alcohol and other substance use on the liver of a person who is infected with HCV.

Screening & Medical Management3

Screening your patients for chronic illnesses like hepatitis C, we know, is of utmost importance. According to the CDC, the following is recommended:

Universal hepatitis C screening :

• Hepatitis C screening at least once in a lifetime for all adults aged 18 years, except in settings where the prevalence of HCV infection is < 0.1%
• Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is < 0.1%

One-time hepatitis C testing regardless of age or setting prevalence among persons with recognized conditions or exposures :

• Persons with HIV Persons who ever injected drugs and shared needles, syringes or other drug preparation equipment, including those who injected once or a few times many years ago
• Persons with selected medical conditions, including persons who ever received maintenance hemodialysis and persons with persistently abnormal ALT levels
• Prior recipients of transfusions or organ transplants, including persons who received clotting factor concentrates produced before 1987, persons who received a transfusion of blood or blood components before July 1992, persons who received an organ transplant before July 1992 and persons who were notified that they received blood from a donor who later tested positive for HCV infection
• Health care, emergency medical and public safety personnel after needle sticks, sharps or mucosal exposures to HCV-positive blood
• Children born to mothers with HCV infection

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Persons At Risk For Hcv Infection

IDU is the most common means of HCV transmission in the United States. Invasive medical procedures pose risks for HCV infection when standard infection-control practices are not followed . Health carerelated hepatitis C outbreaks also stem from drug diversion . Although HCV infection is primarily associated with IDU, high-risk behaviors , primarily among persons with HIV, are also important risk factors for transmission . Other possible exposures include sharing personal items contaminated with blood , unregulated tattooing, needlestick injuries among health care personnel, and birth to a mother with hepatitis C. Receipt of donated blood, blood products, and organs was once a common means of transmission but is now rare in the United States .

Virus Description And Transmission

HCV is a small, single-stranded, enveloped RNA virus in the flavivirus family with a high degree of genetic heterogeneity. Seven distinct HCV genotypes have been identified. Genotype 1 is the most prevalent genotype in the United States and worldwide, accounting for approximately 75% and 46% of cases, respectively . Geographic differences in global genotype distribution are important because some treatment options are genotype specific . High rates of mutation in the HCV RNA genome are believed to play a role in the pathogens ability to evade the immune system . Prior infection with HCV does not protect against subsequent infection with the same or different genotypes.

HCV is primarily transmitted through direct percutaneous exposure to blood. Mucous membrane exposures to blood also can result in transmission, although this route is less efficient. HCV can be detected in saliva, semen, breast milk, and other body fluids, although these body fluids are not believed to be efficient vehicles of transmission .

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Diagnosis And Hepatitis C Elimination

In one report, the National Academies of Sciences, Engineering, and Medicine explored the feasibility of hepatitis C elimination and concluded that hepatitis C could be eliminated as a public health problem in the United States, but that substantial obstacles exist . In another report, specific actions were recommended to achieve elimination considering information, interventions, service delivery, financing, and research . These reports were the culmination of decades of progress in the development of HCV infection diagnostic and therapeutic tools.

In 1990, serologic tests to detect immunoglobulin G anti-HCV by enzyme immunoassay were licensed and became commercially available in the United States, and U.S. blood banks voluntarily began testing donations for anti-HCV . In 1991, U.S. Public Health Service issued interagency guidelines addressing hepatitis C screening of blood, organs, and tissues . These guidelines recommended hepatitis C testing for all donations of whole blood and components for transfusion, as well as testing serum/plasma from donors of organs, tissues, or semen intended for human use .

Addressing Hepatitis For The First Time

It is crucial that a treatment counselor or health professional use a nonjudgmental and compassionate tone. Clients need to feel comfortable disclosing information about their health and risky behaviors. The following strategies can help initiate the conversation:

• Display posters, literature, or other -related items that could help prompt the client to ask questions about hepatitis. .
• Assess clients ability to discuss , based on their degree of openness in the counseling session, the amount of detail they provide in their responses, and the length of the therapeutic relationship.
• Raise the subject in a way that avoids making clients feel defensive or afraid. Consider introducing the subject by making parallels with other conditions that have been discussed. Say, for example, You said you were tested for HIV several times. Were you ever tested for viral ? or You mentioned that your friend is sick with HIV. Have you been tested for HCV or HIV? Tell me about those tests.
• Be patient and allow time for multiple, short conversations about the subject. This might ease feelings of fear, anxiety, or shame.

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Cdc Recommendations For Hepatitis C Screening Among Adults In The United States

• Universal hepatitis C screening:
• Hepatitis C screening at least once in a lifetime for all adults aged 18 years and older, except in settings where the prevalence of HCV infection is less than 0.1%*
• Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is less than 0.1%*

• Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons may be reluctant to disclose stigmatizing risks

Discussing Screening Results With Clients

The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.

Anxiety might interfere with some clients ability to comprehend or retain information, which might need to be repeated.

Suggestions for conversations with clients when the test results are negative include the following:

• Explain results clearly and simply: So the HCV screening result was negative? This means that, as of 6 months ago, you did not have .
• Emphasize that a negative result to an HCV test does not indicate to and that the client should take precautions to avoid . If a relapse to drug use occurs, advise clients to avoid sharing any drug paraphernalia or equipment. Specify that this includes cookers, cotton, water, needles, syringes, pipes, and straws.
• Emphasize the importance of getting HAV and HBV vaccinations. Provide information about the availability of low- or no-cost vaccinations.

Clients whose screening test results are positive for will need additional tests and examinationsusually with doctors who specialize in diseases of the liver to get accurate diagnoses and to determine their health status and the extent of liver damage. These tests are described in .

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Potential Sites For Screening For Hepatitis C

Screening for hepatitis C can be offered in several venues the most likely are primary care offices, emergency rooms, urgent care clinics, and public health fairs.

Following the CDC recommendation, 3 studies were presented at the 2013 meeting of the American Association for the Study of Liver Diseases in Washington, DC. One study was conducted in an emergency department, the second in the outpatient clinics of the US Department of Veterans Affairs, and the third involved individuals undergoing screening colonoscopies for colorectal cancer at a community hospital.36–38 All 3 studies confirmed the higher prevalence of positive serum anti-HCV in individuals born in the years 1945-1965.

All Adults Pregnant Women And People With Risk Factors Should Get Tested For Hepatitis C

Most people who get infected with hepatitis C virus develop a chronic, or lifelong, infection. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. People can live without symptoms or feeling sick, so testing is the only way to know if you have hepatitis C. Getting tested is important to find out if you are infected so you can get lifesaving treatment that can cure hepatitis C.

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Hepatitis C Virus Infection In Adolescents And Adults: Screening

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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