Hepatitis C Virus Antibody Positivity and Predictors Among Previously Undiagnosed Adult Primary Care Outpatients: Cross-Sectional Analysis of a Multisite Retrospective Cohort Study
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Hepatitis C Virus Antibody Positivity and Predictors Among Previously Undiagnosed Adult Primary Care Outpatients: Cross-Sectional Analysis of a Multisite Retrospective Cohort Study

  • Published Date:

    Jan 16 2015

  • Source:
    Clin Infect Dis. 60(8):1145-1152.
  • Language:
    English
Filetype[PDF-103.21 KB]


Details:
  • Alternative Title:
    Clin Infect Dis
  • Description:
    Background Hepatitis C virus (HCV) testing guidance issued by the Centers for Disease Control and Prevention in 1998 recommends HCV antibody (anti-HCV) testing for persons with specified risk factors. The purpose of this study was to determine the prevalence and predictors of anti-HCV positivity among primary care outpatients and estimate the proportion of unidentified anti-HCV-positive (anti-HCV+) persons using risk-based testing. Methods We analyzed electronic medical record data from a 4-site retrospective study. Patients were aged ≥18 years, utilized ≥1 outpatient primary care service(s) between 2005 and 2010, and had no documented evidence of prior HCV diagnosis. Among persons tested for anti-HCV, we fit a multilevel logistic regression model to identify patient-level independent predictors of anti-HCV positivity. We estimated the proportion of unidentified anti-HCV+ persons by using multiple imputation to assign anti-HCV results to untested patients. Results We observed 209 076 patients for a median of 5 months (interquartile range, 1–23 months). Among 17 464 (8.4%) patients who were tested for anti-HCV, 6.4% (n = 1115) were positive. We identified history of injection drug use (adjusted odds ratio [95% confidence interval], 6.3 [5.2–7.6]), 1945–1965 birth cohort (4.4 [3.8–5.1]), and elevated alanine aminotransferase levels (4.8 [4.2–5.6]) as independently associated with anti-HCV positivity. We estimated that 81.5% (n = 4890/6005) of anti-HCV+ patients were unidentified using risk-based testing. Conclusions In these outpatient primary care settings, risk-based testing may have missed 4 of 5 newly enrolled patients who are anti-HCV+. Without knowing their status, unidentified anti-HCV+ persons cannot receive further clinical evaluation or antiviral treatment, and are unlikely to benefit from secondary prevention recommendations to limit disease progression and mortality.
  • Pubmed ID:
    25595745
  • Pubmed Central ID:
    PMC5796763
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