Testing/Screening

This is a chapter of the Enhancing Hepatitis C Testing and Treatment toolkit which provides resources and best practices to help providers to identify and successfully treat hepatitis C infection.

Best Practices

• Maintain formal, written HCV testing/screening protocols.  These should include written documentation of workflows, and a job aid for providers to reference when needed.  All materials should be accessible/shared via document repository or email.
• Incorporate screening into electronic medical record (EMR) through pop-ups/reminders, task boxes, or similar strategies. Add hot button in SBIRT section of EMR to capture data in relation to drug injection practices. If possible, prepopulate subsequent appointments notes for additional review/interviews.
• Offer multiple opportunities for screening e.g. via tablet while patients wait for exam; administered during intake by medical assistant (MA); administered by clinician during examination.
• Many EMRs have tools to support pre-visit planning, population health management, or clinical quality improvement activities.  Explore with your clinic administrator and/or IT department whether these tools can be activated or purchased.  Some community health centers use the Azara DRVS system, which can populate HCV antibody screening into pre-visit planning forms that can be reviewed during pre-clinic MA/Provider huddles. DRVS functionality includes an HCV patient registry.
• Identify specific staff and expected roles/responsibilities relative to various steps in patient flow. For example, MAs conduct assessment of patient and recommend screening; nurse practitioners (NPs) deliver test results and initiate treatment; community health workers (CHWs) conduct follow-up with patients to support medication adherence.
• Implement testing/screening dashboards/benchmarks for staff and monitor as part of routine quality management activities.
• Prioritize patients such as those prescribed suboxone, or patients being treated for STDs.
• Generalize testing such that all orders for HCV antibody testing reflex to HCV RNA and genotype to ensure supplemental testing needed to identify active infection, and to reduce treatment delays.

Resources

• Guidelines for HCV Screening and Treatment in Primary Care – Sections 1-2 (Adapted from Community Health Center of Franklin County)
  The Community Health Center of Franklin County created a tool for clinicians and other staff to support implementation of HCV screening and treatment. The first two sections of the guideline address (1) Screening, and (2) Follow Up Testing.  Other sections of the tool address treatment initiation, management, and follow-up.
• Bundling Antibody and Reflex Testing for Single Blood Draw (Adapted from SSTAR, Fall River)
  SSTAR of Fall River Massachusetts implemented reflex testing to ensure that all patients received the appropriate sequence of tests needed to identify current HCV infection, and to facilitate entry to treatment. This tool describes how they worked with the laboratory vendor to implement HCV antibody testing with reflex to HCV RNA and genotype testing.
• Alcohol & drug use screening (SBIRT, DAST-10)
  • SBIRT (Source: University of Missouri-Kansas City, School of Nursing and Health Studies)
    This resource provides downloadable, validated tools for clinicians to use in screening patients for substance use and to deliver brief interventions (SBIRT Provider Card), and to make appropriate treatment referrals.
  • DAST-10 (Source: National Institute on Drug Abuse)
    The Drug Abuse Screen Test (DAST-10) provides a brief, self-report instrument for population screening.  It is designed to be used with adults and older youth.  This resource provides a downloadable, validated sample tool. 
• Screening Guidelines
  • Recommendation: Hepatitis C Virus Infection in Adolescents and Adults: Screening (Source: US Preventive Services Task Force)
    USPSTF recommends one-time screening for hepatitis C infection to all asymptomatic adults, ages 18 – 79 years, and periodic screening to individuals with continued risk for HCV infection, such as those who use injection drugs (Grade: B Recommendation).  Supplemental HCV RNA testing is recommended for all HCV antibody reactive results.  This resource includes the recommendation statement and accompanying summary of evidence supporting the recommendation as well as links to tools to support clinical practice.
  • Recommendations for Hepatitis C Screening Among Adults - US, 2020 (Source: Centers for Disease Control and Prevention)
    CDC recommends one-time screening for hepatitis C infection for all adults 18 years and older; for pregnant women during each pregnancy, and routine periodic testing for people with ongoing risk factors, such as those who inject drugs.  CDC encourages use of reflex HCV RNA testing to ensure identification of active HCV infection and to expedite linkage to treatment. These recommendations are summarized in an infographic, CDC Recommendations for Hepatitis Screening Among Adults. 
• Laboratory Testing Guidelines
  • Guidance for Laboratory Testing and Result Reporting (Source: Centers for Disease Control and Prevention and Association of Public Health Laboratories)
    This resource describes HCV testing technologies and provides a recommended sequence of tests to identify current HCV infection.  This resource also includes links to an infographic of the Recommended Testing Sequence for Identifying Current HCV Infection, and a tool, Interpretation of Results of Tests for HCV Infection and Further Action, to support clinicians and laboratorians to interpret test results.