Examining Hepatitis C Virus Testing Practices in Primary Care Clinics

C. V. Almario; M. Vega; S. B. Trooskin; V. J. Navarro


J Viral Hepat. 2012;19(2):e163-e169. 

In This Article

Abstract and Introduction


Prior studies found that hepatitis C virus (HCV) risk assessment and testing in primary care clinics were suboptimal. We aimed to determine the actual HCV testing rate among patients with HCV risk factors and to identify variables predictive of testing. In order to do so, we performed a prospective cohort study among patients seen in four urban primary care clinics. At the initial visit, patients were given a questionnaire that listed HCV risk factors and they were instructed to check 'yes' or 'no' if they did or did not have a risk factor, respectively. Patients then handed this questionnaire to their physician during their initial visit. Among those who acknowledged having a HCV risk factor via the questionnaire, we determined the subsequent HCV testing rate and calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) to identify variables predictive of testing. Of the 578 individuals who acknowledged having a HCV risk factor via the questionnaire, only 8% (46/578) were tested for HCV within 2 months of their initial visit. Among those tested, 11% (5/46) had a positive HCV antibody test result. The only variable predictive of HCV testing after adjusting for confounders was having a specific HCV risk factor identified and documented in the chart by physicians [16% (26/159) vs 5% (20/419); aOR 4.5, 95% CI 2.1–9.5]. In summary, 92% of patients with a HCV risk factor were not tested for HCV in the primary care setting, and efforts to improve such rates are clearly warranted.


Hepatitis C virus (HCV) is the most common bloodborne infection in the United States, as 3.2 million individuals are chronically infected nationwide.[1] Furthermore, 40% of chronic liver disease is related to HCV, and HCV-associated end-stage liver disease is the most frequent indication for liver transplantation.[2] Given the significant morbidity and mortality associated with HCV, the Centers for Disease Control and Prevention (CDC),[2] National Institutes of Health (NIH),[3] and American Association for the Study of Liver Diseases (AASLD)[4] all recommend HCV testing for persons at high risk. However, previous studies, most of which were survey based, showed that HCV risk assessment and testing in primary care settings were suboptimal.[5–11] Shehab et al.[5] noted that among primary care physicians (PCPs) surveyed nationwide, only 59% asked all patients about HCV risk factors. A retrospective chart review by Trooskin et al.[11] revealed that PCPs documented a history (positive or negative) of intravenous drug use and blood transfusion prior to 1992 for 12% and 2% of patients, respectively. Furthermore, they also found that of those who admitted intravenous drug use, only 55% were subsequently tested for HCV.[11]

Patient care in primary care settings has become increasingly complex. While the time physicians spent with patients has increased over the years,[12,13] the number of clinical items addressed per visit also increased.[13] Yet, the increase in the number of addressed clinical diagnoses outpaced the increase in visit duration, thereby leading to a decrease in the amount of time devoted to each clinical item.[13] Given the increased demands placed on PCPs along with the fact that most prior studies that examined HCV testing practices were survey based, we aimed to perform a prospective cohort study to determine the actual rate of HCV testing among primary care patients with a HCV risk factor and to identify factors predictive of testing.


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