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Managing Hepatitis C in Vermont
Module 2: Screening for HCV
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Welcome to the Screening for HCV module
Please take this brief pre-module quiz Click here for brief pre-module quiz or use this web address:
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This module works a lot better in “presentation” mode
Above, go to “Slide Show” then hit “From Beginning” and click-through
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Screening for HCV: Outline
Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm
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Screening for HCV: Outline
Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm
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Why screen for HCV? Identification of hepatitis C infected individuals allows linkage to curative treatment, which has two benefits: Benefit to the patient: Benefit to public health: Reduction in long term complications of decompensated cirrhosis and hepatocellular carcinoma Reduction in the pool of HCV infected persons and consequent reduction in disease transmission
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Screening for HCV: Outline
Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm
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Who should be screened for HCV
Anyone with any of the following: Born between History of injection drug use History of incarceration Received clotting factors before 1987 Received blood transfusion or organ donation before 1992 Children of HCV-infected mothers History of needle stick injury History of sex with HCV-infected person (in particular men who have sex with men) Evidence of liver disease or abnormal serum aminotransferase levels Hemodialysis HIV
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Screening for HCV in the US: improvement sorely needed
0.6M on HCV therapy 3 million have +HCV RNA 4 million have +HCV antibody 80 million fit screening criteria Screening includes birth cohort and those at increased risk based on lifestyle factors
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Screening for HCV: multiple breaks in chain from diagnosis to cure
In one study from Denver Health… More testing and better linkage to HCV care needed Inadequate screening Inadequate HCV RNA testing Numbers of patients Inadequate treatment or referral Rowan SE, Durfee J, Tabano DC, et al. The association between HCV and comorbid conditions in 2 large patient cohorts. CROI, February 13-16, 2017, Seattle. #528
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Screening for HCV: Outline
Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm
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Addressing barriers to screening in VT
Community awareness programs in at-risk populations Reducing the stigma of hepatitis C through public health campaigns Improving outreach of point-of-care testing beyond medical offices Automated reminders for primary health professionals Particularly for the “Baby Boomer” cohort, born between 1945 and 1965
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Screening for HCV: Outline
Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm
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Test serum hepatitis C (HCV) antibody (Ab) in the following groups
Anyone with any of the following: Born between History of injection drug use History of incarceration Received clotting factors before 1987 Received blood transfusion or organ donation before 1992 Children of HCV-infected mothers History of needle stick injury History of sex with HCV-infected person (in particular men who have sex with men) Evidence of liver disease or abnormal serum aminotransferase levels Hemodialysis HIV HCV Ab positive Indicates HCV exposure HCV Ab negative HCV RNA not detected Naturally cleared HCV infection or previously treated Repeat HCV RNA in future if ongoing risk Check serum HCV RNA Indicates no HCV exposure. Repeat HCV Ab in future if ongoing risk HCV RNA detected Active HCV infection See Module 3
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Screening for HCV: Key Points
Many patients in the USA and Vermont are unaware they have chronic HCV infection Screening benefits both them and reduces further transmission Screening efforts have lagged behind need. Targeted screening of high- risk groups is essential An HCV antibody is the standard screen, and is confirmed with an HCV RNA viral load Patients who have naturally or medically cured HCV will always have a positive HCV antibody and should be re-screened with an HCV RNA viral load Next Step: Module 3: The Post Screening Process
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Congratulations! Please take the post-module quiz here
Click here for brief post-module quiz or use this web address:
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