Barriers to Hepatitis C Screening and Testing

Posted on March 31, 2015

US Healthcare Providers Share Perspectives on Barriers to Hepatitis C Screening and Testing

In 2012, the Centers for Disease Control and Prevention (CDC) recommended that all individuals born during 1945 to 1965 (the birth cohort with the highest prevalence of HCV) receive a onetime test for HCV, assessment for alcohol use and intervention as indicated, and linkage to care and treatment as appropriate. CDC’s 2012 recommendations supplement the 1998 recommendations, which indicated HCV testing of those with risks of exposure. Note that the 1998 recommendations had limited effectiveness in identifying a broader population of those infected with HCV.

Results of healthcare provider interviews to identify current perspectives, practices, facilitators, and barriers to HCV screening and testing were recently published in the journal Health Promotion Practice, as part of the Birth Cohort Evaluation to Advance Screening and Testing for Hepatitis C project supported by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (Jewett et al, Health Promotion Practice. March 2015 Vol. 16, No. 2, 256–263). The interviewed providers (6 PCPs, 5 administrators, and 8 hepatologists) came from the following four large US primary care systems: Henry Ford Hospital, Detroit, Michigan; Mount Sinai Hospital, New York, New York; University of Alabama at Birmingham, Birmingham, Alabama, and the University of Texas Health Science Center at Houston, Houston, Texas.

Feedback from these interviews suggests four main reasons why the CDC’s 1998 recommendation might have been ineffective:

  1. The large number of risk factors included in these recommendations requires physicians to acquire new knowledge, and their disinclination or lack of time to do so would inhibit testing.
  2. Providers are reluctant to elicit information that would call for testing because they are uncomfortable discussing socially stigmatizing behaviors with their patients, or lack time.
  3. Providers hesitate to test for HCV because they fear that patients’ insurers would not reimburse costs for testing or clinical treatment among newly diagnosed patients.
  4. Some physicians believe that implementation of the guidelines will not benefit patients because patients will not access care and treatment or treatment might be ineffective.

Simpler recommendations with fewer indications requiring less knowledge and skill acquisition are likely to be more widely adopted as a routine element of clinical practice, which should mean easier adoption of the CDC’s 2012 birth cohort screening recommendations. If the CDC’s birth cohort screening recommendations are adopted widely by physicians, it is probable that there will be a considerable increase in the number of individuals identified as being infected with HCV; however, success is dependent on the availability of care to provide patients with treatment and medical support. Do you agree with the findings of this article? How do they relate to your practice?

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