June 20, 2011 — A new study indicates that patients support universal screening for hepatitis C virus (HCV) infection, even in the absence of prior consent or communication of negative results. The study was published online June 6 in BMC Infectious Diseases.
Between 2.9 and 3.7 million people in the United States are infected with HCV, and about 70% are unaware of it. Between 20% and 30% of the infected patients will go on to develop cirrhosis. HCV is the most common cause of liver failure among liver transplant patients.
Current therapies achieve about a 50% cure rate, and broad implementation could reduce HCV complications by 16% to 42%.
Current screening guidelines direct physicians to screen patients when they have one or more risk factors, such as injected drug use, having received a blood transfusion before 1992, or elevated liver function tests. However, such screening is complicated because patients may not admit to past behaviors such as drug abuse, among other limitations, including not capturing other potential risk factors such as possible remote iatrogenic transmission.
To gauge the public's opinion on potential HCV screening programs, in August 2010 the researchers, led by Phillip O. Coffin, MD, MIA, from the Division of Allergy and Infectious Diseases, University of Washington, Seattle, conducted a survey at 5 outpatient clinics of a major public urban medical center in Seattle. The response rate was 85.8% (200 responses of 233 patients surveyed). The study group had a median age of 47 years and included 55.3% women. Of the participants, 56.3% were white, 32.7% were black, 9.5% said they had been tested positive for HCV, and 2.5% reported testing positive for HIV.
The survey included 3 options: universal testing without being informed of the test or being told of negative results (48% preferred this option); testing with an opportunity to opt out, and without being informed of negative results (37% preferred); and testing based on clinician judgment (15% preferred).
Limitations of the study include the lack of both generalizability and disease confirmation status reported by the participants. In addition, the respondents were not asked all of the same questions, which limited comparisons. This was also a quantitative, not qualitative, analysis, which may alter results.
"[P]atients appear to place a higher priority on being tested than they do on the process of informed consent or the receipt of negative results. These findings should inform the priorities of clinicians, public health officials, and clinical risk managers," the authors conclude.
Dr. Coffin’s work is supported by a grant from the National Institute of Allergy and Infectious Diseases. The authors have disclosed no relevant financial relationships.
BMC Infect Dis. Published online June 6, 2011. Full text