Detection of previously undiagnosed or lost to follow-up hepatitis C infections by implementing an opportunistic screening in an emergency department

Abstract

Objectives

This study aimed to evaluate the effectiveness of an opportunistic hepatitis C virus (HCV) screening program in identifying new cases and ensuring their follow-up (linkage to care) in our health area.

Methods

We conducted a prospective study from June 2023 to May 2024 in an emergency department (ED) of Catalonia (Spain), screening patients aged 30–70 years who had blood samples collected as part of routine clinical practice. Patients with positive anti-HCV antibodies were confirmed with HCV RNA testing, and those with active infection were referred to the gastroenterology department for care.

Results

Out of 15,245 eligible patients, 5184 were screened for HCV, marking a 192% increase compared to the previous year. Of total serologies, 3973 were requested in patients aged between 30–70 years and the rest by routine clinical practice. Anti-HCV antibodies were detected in 120 patients (3.02%), and 13 (0.33%) had active HCV infection. The mean age of viremic patients was 49.62 years and 76.92% were male. Identified risk factors included drug use (63.64%) and being from countries with high HCV prevalence (18.18%). Advanced liver fibrosis was found in 25% of patients.

Conclusions

Opportunistic screening in the ED significantly increased HCV testing and identified a higher prevalence of active infection compared to the general population. These findings support expanding screening guidelines to reach broader populations, improving early diagnosis and linkage to care for HCV.