Half a Diagnosis: Gap in Confirming Infection among Hepatitis C Antibody-positive Patients

The American Journal of Medicine
Volume 126, Issue 8 , Pages 718-722, August 2013

Emily McGibbon, MPH, Katherine Bornschlegel, MPH, Sharon Balter, MD

New York City Department of Health and Mental Hygiene, Long Island City, NY

published online 19 June 2013.

Abstract

Background

Recent guidelines recommend testing all individuals born during 1945-1965 for hepatitis C virus (HCV) antibody. For antibody-positive patients, subsequent RNA testing is necessary to determine current infection status. This study aimed to assess whether clinicians order HCV RNA tests as recommended for antibody-positive patients and to identify barriers to such testing.

Methods

We sampled individuals newly reported to the New York City Department of Health and Mental Hygiene's HCV surveillance system and collected information from clinicians. For patients without RNA test results, we asked the reason an RNA test was not ordered and requested that the clinician order the test.

Results

Of 245 antibody-positive patients, 67% were tested for HCV RNA (for 21% of these, the test was ordered only after our request); 33% had no RNA testing despite our request. Patients without RNA testing were seen in medical facilities (47%), detox facilities (30%), and jail/prison (15%). Reasons RNA testing was not done were that the patient did not return for follow-up (35%), the facility does not do RNA testing (22%), and the patient was tested in jail (15%).

Conclusions

In our study, one third of patients did not get complete testing for accurate diagnosis of HCV, which is essential for medical management. Additional education for clinicians about the importance of RNA testing may help. However, with improved antiviral treatments now available for HCV, it is time for reflex HCV RNA testing for positive antibody tests to become routine, just as reflex Western blot testing is standard for human immunodeficiency virus.

Keywords: Hepatitis C, Surveillance, Testing

Funding: This work was supported in part by an Emerging Infections Program grant for hepatitis surveillance from the Centers for Disease Control and Prevention.

Conflict of Interest: None.

Authorship: All authors had access to the data and a role in writing the manuscript.

PII: S0002-9343(13)00228-3

doi:10.1016/j.amjmed.2013.01.031

© 2013 Elsevier Inc. All rights reserved.

Source