High Prevalence of Hepatitis C Infection Identified through Targeted Screening in a Sexually Transmitted Disease Clinic in North Carolina

Background:  Screening for hepatitis C virus (HCV) infections is limited among patients presenting to STD clinics.  We analyzed data from a targeted HCV screening program integrated into an STD clinic in order to identify the prevalence of HCV infection and assess provider perspectives regarding impact on services.

Methods:  Targeted HCV screening with HCV antibody and reflex RNA testing was initiated in December 2012 at the public STD clinic located in Durham, North Carolina based on specific patient risk factors (e.g. birth year, injection drug use [IDU], incarceration, sexual history, history of incarceration, medical history, HIV status).  We estimated the proportion of persons identified with HCV infection among individuals screened.  Qualitative data regarding the program were assessed from an anonymous survey of STD clinic providers.  

Results:  Over a 28-month period, 733 patients underwent targeted HCV screening in the STD clinic, of whom 66% were male, 69% were Black, and 50% were born during 1945-1965.  One hundred eight persons (15%) were HCV antibody positive, of whom 81 (11%) had detectable HCV RNA results indicating chronic infection.  The highest proportions of chronically infected individuals were among those who reported IDU (52%), prior incarceration (25%), sex with an HCV-infected partner (23%), sex with a partner endorsing IDU (21%), and/or transactional sex (20%).  STD providers (n=5) indicated that it was easy to integrate HCV messages in the clinic, but that it was important to have access to local HCV linkage-to-care services.  Although HCV screening activities added approximately 10 minutes to each visit and impacted workflow, providers agreed that local health departments should offer HCV testing.     

Conclusions:  A targeted HCV screening program based on individual risk factors can identify a significant proportion of chronically HCV infected patients in an STD clinic setting.  Successful implementation must consider resources for HCV screening and linkage to care, and impact on clinic processes.