Health Policy and Health Services Research
Background: The most important risk factor for HCV infection is past or current injection drug use with 60% of new HCV infections occurring in persons who report injection drug use within the past 6 months. Hepatitis C is most often acquired percutaneously in comparison with other blood borne pathogens such as Hepatitis B, HIV and Syphilis but coinfection is also likely to occur because of sexual practices associated with injection drug use. We sought to describe the self-reported knowledge of screening for Hepatitis C and other related infections in a population of subjects attending the emergency department in an area that is seeing increasing opioid overdoses.
Methods: Academic associates in the emergency department enrolled a convenience sample of adult, non-critical and non-pregnant patients and asked them to complete a computerized survey of their awareness of their own personal screening history for a variety of conditions. The survey was presented in a branched logic fashion so that subjects were only queried about conditions for which they were considered at risk based on self -reported characteristics and United States Preventative Services Task Force Guidelines. Conditions assessed included Hepatitis B, Syphilis, hyperlipidemia, various cancers, aortic aneurysm, osteoporosis, and gonorrhea/chlamydia.
Results: We enrolled 1746 subjects of which 1735 completed the survey. Of these 53% were female and the mean age was 46 (±18), 74% white. Of the 1735 subjects, 523 were determined to be at risk for Hepatitis C. Of those at risk, 243 (46%) reported an awareness of having been screened and 7% reported being positive for Hepatitis C. In contrast, 258 reported having been screened for HIV of whom just 5 (2%) were positive.
Conclusion: The emergency department represents an opportunity to screen potentially at risk adults for a myriad of diseases including Hepatitis C and HIV. Screening for Hepatitis C may be an opportunity to also screen for injection drug use in a less confrontational manner and to offer the opportunity to refer for treatment and to recommend methods to reduce disease transmission.