The birth cohort approach to screening for hepatitis C was
adopted by the CDC due to the high prevalence of HCV in baby boomers and the cost-effectiveness of screening in an older population. Three quarters of all
chronic hepatitis C cases are estimated to be in baby boomers, and older people
infected several decades ago are at higher risk of complications arising from
advanced liver damage.
Monitoring of compliance with screening guidelines is
essential in order to see whether hepatitis C treatment is fulfilling its
potential to avert large-scale morbidity and mortality, and to identify how
services can be improved.
Monitoring further steps in the continuum of care, or
treatment cascade, can identify barriers to being cured of hepatitis C.
NorthShore University Health System cares for around 250,000
baby boomers in Chicago. To check compliance with HCV testing recommendations,
researchers identified all people born between 1945 and 1965 who visited a
clinic in July 2015 and to determine whether they were tested for HCV, and why.
The study found that, of 10,089 patients eligible for
screening on a clinic visit, only 131 (1.3%) had been tested for HCV
antibodies. Of these, 28 had been tested due to risk factors for HCV infection,
34 had been tested as part of a diagnostic investigation and 69 had been tested
as a member of the birth cohort. The testing rate was especially low in
patients who saw a primary care physician (Yeboah-Korang).
The TILT-C programme screened baby boomers from the
1945-1965 birth cohort at Grady Memorial Hospital Primary Care Center in
Atlanta. Between 2012 and 2014 5239 people were screened, of which 92.5% were
African-American and 53% uninsured. Of these, 412 (7.9%) tested positive for
HCV and 92% underwent HCV RNA testing to determine chronic infection status. A total of 264 had chronic HCV infection (69%). Of these, 96% were linked to care, 75%
attended a second visit and only 43% of these were referred for treatment. Just
over half of those referred for treatment eventually started treatment within
20 months of the end of the screening programme, and to date, 25 patients have
been cured of HCV (confirmed SVR12)(Miller).