Hep C Testing
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Nontargeted hepatitis C virus (HCV) screening in emergency departments (EDs) identifies significantly more new infections than targeted, risk-based screening, according to results from the DETECT Hep C randomized clinical trial published July 9 in JAMA. Among 147,498 ED patient visits randomized across three urban hospitals, nontargeted screening yielded 154 new HCV diagnoses compared with 115 in the targeted screening group, a 34% relative increase (relative risk (RR), 1.34; 95% CI, 1.05–1.7; P = .02).1
The trial, conducted at EDs in Denver, Baltimore, and Jackson, assigned patients aged 18 and older to one of two screening strategies as part of routine care. In the nontargeted group (n = 73,847), HCV testing was offered universally, leading to 9,867 patients being tested (13.4%) and 154 new diagnoses. In the targeted group (n = 73,651), patients were screened based on documented risk factors, resulting in 23,400 (31.8%) being identified as at-risk, 4,640 tested (6.3%), and 115 new HCV cases detected. The demographic profile of participants included a median age of 41 years (IQR, 29–57), 51.5% male, 42.3% Black, 20.9% Hispanic, and 32.2% White.1
Despite improved detection rates with nontargeted screening, linkage to care and treatment initiation remained limited across both groups. Among patients with newly diagnosed HCV infection, only 19.5% in the nontargeted group and 24.3% in the targeted group engaged in follow-up care. Direct-acting antiviral (DAA) therapy was initiated in 15.6% vs 17.4%, completed in 12.3% vs 12.2%, and resulted in sustained virologic response at 12 weeks (SVR12) in just 9.1% vs 9.6% of patients, respectively.1
What You Need To Know
Nontargeted HCV screening in emergency departments identified 34% more new infections than targeted, risk-based screening.
Less than 10% of newly diagnosed patients in either group completed treatment and achieved sustained virologic response at 12 weeks.
The findings reveal a critical gap between diagnosis and care, highlighting the need for integrated treatment pathways within or connected to ED settings.
A January 2025 study published in The American Journal of Emergency Medicine further supports the role of emergency departments in HCV screening, while echoing concerns raised by the DETECT Hep C trial about poor linkage to care. Conducted at a safety-net hospital, the study assessed universal HCV screening from 2019 to 2022 and found that among 9,511 ED patients screened, 6.9% were anti-HCV positive and 3.4% had active infection (HCV RNA positive). Despite this relatively high prevalence, only 24.1% of those with confirmed HCV were successfully linked to care, and just 17.8% initiated antiviral treatment. Notably, HCV prevalence was significantly higher in the ED cohort compared to outpatient clinics within the same health system, highlighting the ED’s potential as a critical access point for diagnosis among underserved populations.2
The CDC’s 2025 updated recommendations endorse universal hepatitis C screening for all adults aged 18 and older and all pregnant women during each pregnancy, reflecting a shift away from risk-based testing toward broader, population-level screening. This aligns closely with the DETECT Hep C trial’s finding that nontargeted (universal) screening in emergency departments identifies more new HCV infections than targeted approaches.3
CDC emphasizes the importance of rapid diagnosis and automatic reflex testing (HCV RNA after a reactive antibody test) to reduce delays between screening and treatment initiation, an area highlighted as a gap in the DETECT trial and similar ED studies. The CDC also stresses that many infected individuals are asymptomatic and unaware of their status, underscoring the critical need for universal screening in high-volume clinical settings like ED’s.3
Moreover, the CDC outlines priority populations for frequent testing but encourages testing anyone who requests it, supporting a low-threshold, stigma-free approach. Their guidance on streamlined testing and linkage to care complements the DETECT trial’s call for innovative models to improve the hepatitis C care continuum, especially among underserved populations often seen in ED.3
Together, these findings underscore not only the effectiveness of nontargeted screening in high-throughput settings such as EDs but also the substantial drop-off along the HCV care continuum, from diagnosis to treatment and cure. According to the authors, urgent development of innovative strategies is needed to enhance linkage to care and ensure treatment follow-through in populations diagnosed in emergency settings.