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.
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.
Authors: Monica A Konerman; Mary Thomson; Kristen Gray; Meghan Moore; Hetal Choxi; Elizabeth Seif; Anna S F Lok Journal: Hepatology Date: 2017-09-14 Impact factor: 17.425
Authors: Anthony K Yartel; Rebecca L Morgan; David B Rein; Kimberly Ann Brown; Natalie B Kil; Omar I Massoud; Michael B Fallon; Bryce D Smith Journal: Am J Prev Med Date: 2015-04-18 Impact factor: 5.043
Authors: Lucia V Torian; Uriel R Felsen; Qiang Xia; Fabienne Laraque; Eric J Rude; Herbert Rose; Adam Cole; Angelica Bocour; Gary J Williams; Robert F Bridgforth; Lisa A Forgione; Howard Doo; Sarah L Braunstein; Demetre C Daskalakis; Barry S Zingman Journal: Am J Public Health Date: 2018-03-22 Impact factor: 9.308
Authors: Ashly E Jordan; Charles M Cleland; Bruce R Schackman; Katarzyna Wyka; David C Perlman; Denis Nash Journal: J Infect Dis Date: 2020-09-02 Impact factor: 5.226