Session number: 1146
Abstract title: Hepatitis C Testing in the VHA Northwest Network – Prevalence, Risk Markers & Future Recommendations
Author(s):
KL Sloan - VA Puget Sound Health Care System & Department of Psychiatry and Behavioral Sciences, University of Washington
KA Straits-Tröster - VA Puget Sound Health Care System & Department of Psychiatry and Behavioral Sciences, University of Washington
JA Dominitz - Seattle Epidemiologic Research and Information Center and HSR&D, VA Puget Sound Health Care System & Department of Medicine, University of Washington
DR Kivlahan - VA Puget Sound Health Care System & Department of Psychiatry and Behavioral Sciences, University of Washington
Objectives: The purpose of this study was to (1) investigate changes in the tested prevalence of HCV among veterans in the Veterans Healthcare Administration (VHA) Northwest Network over time, (2) relate HCV serologic status to risk markers determinable from the electronic medical record, and (3) consider how future testing efforts might be most efficiently targeted.
Methods: We retrospectively reviewed computerized medical records to identify the serology status and related medical and demographic variables for all veterans tested for HCV infection from October 1994 through December 2000 at any of the eight Department of Veterans Affairs Medical Centers of the VHA Northwest Network.
Results: Among the 37,953 veterans tested, 8,237 (21.7%) had evidence of current or prior HCV infection. Over the period from 1995 to 2000, the annual number of unique individuals tested increased from 2,336 to 18,193 while the proportion of new positive tests decreased from 36% to 10%. Over 1000 new cases were identified in each of the past five years. Individuals with diagnoses of drug use disorders, repeatedly elevated alanine transaminase levels, or positive hepatitis B serology were most likely to test positive and characterized 91% of the HCV+ group. Only 21% of the year 2000 VISN 20 user population had these documented risk factors. Among individuals with any of these risk factors, 35% of those tested were positive for HCV, but only 50% had ever been tested. Of the population tested, the proportion with one or more of these risk factors dropped from 77% in 1995 to 40% in 2000.
Conclusions: Although the number of unique patients tested for HCV infection has increased annually and over a thousand new cases per year test positive, testing has become less targeted toward high-risk individuals. Utilization of data from computerized medical records could improve testing efficiency by targeting individuals with positive hepatitis B serology, drug dependence diagnoses or elevated ALTs.
Impact statement: HCV testing has become less focused on several important readily identifiable risk factors over time. Improved utilization of existing VistA data (e.g., via clinical reminders) may help to ensure testing on this group of high-risk individuals.