PCSI in Practice: Fully Integrated Screening for Hepatitis C Virus in an STD Clinic

Background: Hepatitis C virus (HCV) is the most prevalent chronic blood-borne infection in the United States. Despite its frequency and complications, HCV infection is often neglected. To increase the proportion of persons aware of their infection status and provide counseling and linkage to care for infected clients, we integrated rapid HCV testing and linkage into standard STD clinic operations.

Methods: All clients presenting to the Denver Metro Health Clinic are screened for HCV risk at triage. Clients reporting at least one risk factor or those who fall in the 1945-1965 birth cohort are tested for HCV antibody using a rapid test (reactive specimens are confirmed with quantitative RNA). All men who have sex with men (MSM) are also offered an HCV test. Clients with a reactive rapid result are offered counseling and referral services from an HIV/HCV Linkage to Care (LTC) counselor. 

Results: Between January and September 2013, a total of 1,645 clients (median age 31, IQR: 25-45; 80% male; 50% white, 16% black, 27% Hispanic) were screened for HCV antibody. Approximately 6% (102) reported ever injecting drugs, 4% (59) reported having an HCV+ sex partner, 25% (407) received a tattoo in an unprofessional setting, and 32% (518) shared equipment to snort drugs. A total of 270 (16%) clients reported birth cohort as their only risk factor (5 had confirmed virus). Additionally, 408 clients who identified as MSM reported no other risk factors (none were HCV infected). Of all clients screened for HCV, 40 (2.4%) were antibody positive. Of the 36 specimens with a valid HCV RNA result, 25 (69.4%) had confirmed virus. All but 2 clients with a reactive rapid result met with an LTC counselor.  

Conclusions: Despite the lower than expected positivity, fully integrating HCV screening into the STD clinic provides the opportunity for preventive counseling and education around HCV.