Nontargeted Hepatitis C Screening Yields More Diagnoses

TOPLINE:

Nontargeted hepatitis C virus (HCV) screening in emergency departments (EDs) was superior to targeted screening for identifying new HCV infections in a prospective randomized screening trial. However, only a small proportion of diagnosed patients achieved sustained virologic response at 12 weeks, emphasizing the need for better HCV treatment models.

METHODOLOGY:

• A prospective, multicenter, randomized DETECT HCV clinical trial was conducted at three urban EDs in the US, involving 147,498 adult patients (median age, 41 years; 51.5% men) with diverse racial demographics (42.3% Black, 20.9% Hispanic, and 32.2% White).
• From November 2019 to August 2022, 73,847 patients (50.1%) were randomized to undergo nontargeted HCV screening (HCV testing offered regardless of risk). Among the 73,651 patients (49.9%) randomized to targeted HCV screening (testing offered on the basis of risk assessment), 23,400 (31.8%) were identified as having increased risk.
• The primary outcome was a newly diagnosed HCV infection with detectable RNA and no known prior HCV diagnosis.
• Secondary outcomes included repeat diagnoses; HCV test offer, acceptance, and completion rates; HCV genotype and fibrosis staging; components of the HCV care continuum; and 18-month all-cause mortality.

TAKEAWAY:

• Nontargeted screening resulted in significantly more new HCV diagnoses than targeted screening (154 vs 115; relative risk [RR], 1.34; P = .02).
• Nontargeted HCV screening yielded higher testing rates than targeted screening, with 3.1 times more participants in the nontargeted group being offered testing (89.0% vs 28.5%; P < .001), a higher percentage accepting testing (22.4% vs 9.7%; P < .001), and 2.1 times more participants completing the test (13.4% vs 6.3%; P < .001).
• Differences in linkage to care remained nonsignificant between the groups (19.5% vs 24.3%; P = .37), with similar rates of treatment initiation (15.6% vs 17.4%; P = .74), treatment completion (12.3% vs 12.2%; P > .99), sustained virologic response at 12 weeks (9.1% vs 9.6%; P > .99), and all-cause mortality at 18 months (5.2% vs 4.3%; P > .99).
• Among 269 newly diagnosed patients, the 112 (41.6%) with ongoing risk — such as injection drug use — had lower linkage to care (16.1% vs 25.5%; P = .06), lower completion of direct-acting antiviral treatment (5.4% vs 17.2%; P = .004), and lower sustained virologic response (5.4% vs 12.1%; P = .06) than those without recent injection drug use.

IN PRACTICE:

“This multicenter randomized clinical trial determined a nontargeted screening approach was superior to targeted screening for identifying new HCV infections among patients seen in three urban EDs. The substantial decrease in patients who went from diagnosis to SVR12 [sustained virologic response at 12 weeks] highlights an urgent need for innovative models of HCV treatment,” the authors concluded.

SOURCE:

The study was led by Jason Haukoos, MD, MSc, Department of Emergency Medicine, Denver Health, Denver. It was published online on July 09, 2025, in JAMA.

LIMITATIONS:

The generalizability of the study outcomes was limited by the inclusion of only three EDs experienced in infectious disease screening. Changes in ED workflows, screening implementation, and the HCV care continuum during the COVID-19 pandemic likely contributed to delays in secondary outcomes. The study was further limited by the exclusion of a large number of ED visits due to high acuity or lack of consent, potential misclassification bias, and the inability to draw clear inferences from the HCV care continuum and secondary outcomes.

DISCLOSURES:

The study was funded by the National Institute on Drug Abuse. Rothman reported receiving grants from the Gilead Sciences FOCUS program and the Baltimore City Health Department during the conduct of the study. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.