Background: Hepatitis C (HCV) screening in Emergency Departments (EDs) can have positive public health impacts. Our experience with a universal, non-targeted, HCV screening program demonstrated that 70% of ED patients refused an initial nurse offer of HCV testing. We sought to determine the effect of reengagement on testing outcomes after an initial test refusal.
Methods: A program evaluation of universal, non-targeted HCV screening was conducted on patients presenting to an urban ED between June 6 and Nov 27, 2018. All adults 18 and above were offered HCV testing during the initial nurse assessment. Patients who declined the nurse testing offer were reengaged by health educators (HEs). At most, 3 reengagement attempts were made.
Results: During the evaluation period, there were 40,679 adult ED visits and 4,649 reengagement encounters. Most (93.5%, n=4,345) reengagement encounters were in patients who refused the nurse offer of HCV testing. HEs also reengaged 5.8% (269/4,649) patients not offered HCV testing by the nurse because they were incapacitated, had a life threatening emergency, were known HCV+ or had another documented reason for no test offer. In most cases (99%, n=4,614/4,649) patients were approachable for reengagement. There were 367 reengagement encounters (8%) for patients who had been previously tested in the screening program. Of the remaining encounters (n=4,247) 25% and 6.5% had a 2nd and 3rd reengagement attempted, respectively. Most repeat reengagements occurred because patients were sleeping or not in their room. In total, 54% (n=2,305/4,247) of all reengagements resulted in a discussion between the HE and the patient about HCV testing, after which 820 patients (36%, [803/2,305]) agreed to HCV testing and 76% (n=636/803) had an HCV test performed. This accounted for 12% of the total number of HCV tests performed (636/5,270) during the evaluation period. Out of the 636 tests performed after reengagement, 53 were HCV Ab+; almost half of these (47%, n=25/53) were VL+.
Conclusion: Reengaging patients who initially refused a nurse offer of HCV testing resulted in a moderate (12%) increase in the number of HCV tests performed in a universal, non-targeted HCV screening program. Patients with active HCV infection, who might have otherwise refused testing, were convinced to test after reengagement, enabling identification of their infection and linkage to care.