Hepatitis C Screening in the Birth Cohort (1945-1965)

Hepatitis C is one of the most common blood borne pathogens in the United States. It is an insidious infection that frequently remains asymptomatic in its host, causing damage years after initial contact. The negative health effects of an undiagnosed hepatitis C infection often include liver cirrhosis and hepatocellular carcinoma. Individuals born in years 1945-1965 have a higher prevalence of hepatitis C than any other cohort. In an effort to reduce this prevalence and the associated negative health outcomes, the Centers for Disease Control and prevention (CDC) has recommended that every person born during this time period be screened for hepatitis C. In order for this effort to be successful, a rapid uptake and widespread use of this recommendation needs to occur. Negative health sequela often do not manifest until later in life with the peak age being around 60. As such, identifying the infection earlier in this birth cohort will be advantageous in preventing negative health outcomes, premature mortality and reducing healthcare costs. Evidence surrounding prior screening efforts and recommendations suggest that there is often a significant lag in time between recommendations and provider/patient uptake. A prolonged period of acceptance will undermine the purpose of the recommendation. One way to increase screening frequency is to tie hepatitis C screening to other common preventative screenings such as colonoscopy. Screening colonoscopies are an age based screening starting at age 50. Coincidentally, this age aligns perfectly with the birth cohort of 1945-1965 making it an opportune time to screen for hepatitis C. For the purposes of this project, the primary objective was to create a program that increased frequency of screening for hepatitis C by offering to screen patients for hepatitis C at the time of screening colonoscopy. Additionally, the program was implemented in a way that will allow for screenings to take place after the termination of the project. Finally, dissemination of the results of this project is an important part of creating momentum in the effort the increase screenings. Utilizing a local endoscopy center, a willing provider and the endoscopy staff were invited to participate in a 5 week program to screen for hepatitis C when seeing patients of the appropriate age. The number of new screenings was compared to baseline screening frequency to determine the efficacy of the intervention. The simple program design allowed the endoscopy center to tailor the program to their needs and continued screening. Dissemination of project results was accomplished by submission of application for a poster presentation at local Snowbird CME conference. Efforts to increase screening for hepatitis C are needed to avoid unnecessary morbidity and mortality amongst the 1945-1965 birth cohort. Coupling hepatitis C screening with colonoscopy screening is a promising strategy to accomplish an increase while adhering to CDC recommendations.