NEW findings suggest that non-targeted screening for hepatitis C virus (HCV) may be more effective than targeted screening for identifying new HCV infections in the emergency department (ED). The diagnosis of HCV infection is a public health priority, and due to the large number of at-risk patients seeking care at EDs, screening is essential in this context.
A prospective, multicentre randomised trial aimed to evaluate the effectiveness of HCV screening in EDs, with researchers hypothesising that non-targeted screening would lead to more diagnoses. The primary outcome was newly diagnosed HCV infection, and secondary outcomes included HCV test offer, acceptance, and completion; repeat HCV diagnoses; components of the HCV care continuum; HCV genotype and fibrosis staging; and all-cause mortality at 18 months of follow-up. A total of 147,498 patients were randomised to undergo non-targeted screening (73,847 patients; HCV testing offered regardless of risk) or targeted screening (73,651 patients; testing offered based on risk assessment). In the non-targeted screening group, 9,867 (13.4%) were tested for HCV and 154 HCV diagnoses were made. In the targeted screening group, however, 23,400 patients had risk factors for HCV infection, with 4,670 (6.3%) testing for HCV and 115 HCV diagnoses made.
Non-targeted HCV screening identified significantly more new HCV infections compared to targeted HCV screening (RR: 1.34; 95% CI: 1.05–1.70; p=0.02). Researchers further noted that only a small proportion of patients from both groups were linked to follow-up care (19.5% and 24.3%), started direct-acting antiviral treatment (15.6% and 17.4%), completed their treatment (12.3% and 12.2%), and attained sustained virologic response at 12 weeks (9.1% and 9.6%).
The team concluded that the non-targeted screening approach was superior to targeted screening for diagnosing HCV in EDs. They also called attention to the need for innovative models of HCV treatment due to the low number of patients attaining sustained virologic response at 12 weeks.
Reference:
Haukoos J et al. Hepatitis C screening in emergency departments. JAMA. 2025;DOI:10.1001/jama.2025.10563.
