{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:45:09Z","timestamp":1761864309016,"version":"3.40.5"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T00:00:00Z","timestamp":1623283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Chronic hepatitis C virus infection (HCV) is a common infectious disease that affects more than 2.7 million people in the US. Because the emergency department (ED) can present an ideal opportunity to screen patients who may not otherwise get routine screening, we implemented a risk-based screening program for ED patients and established a system to facilitate linkage to care.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>A risk-based screening algorithm for HCV was programmed to trigger an alert in Epic electronic medical record system. Patients identified between August 2018 and April 2020 in the ED were tested for HCV antibody reflex to HCV RNA. Patients with a positive screening test were contacted for the confirmatory test result and to establish medical care for HCV treatment. Patient characteristics including age, sex, self-awareness of HCV infection, history of previous HCV treatment, history of opioids use, history of tobacco use, and types of insurance were obtained.<\/jats:p>\n<jats:p>A total of 4,525 patients underwent a screening test, of whom 131 patients (2.90%) were HCV antibody positive and 43 patients (0.95%) were HCV RNA positive, indicating that only 33% of patients with positive screening test had chronic HCV infection. The rate of chronic infection was higher in males as compared to females (1.34% vs 0.60%, p = 0.01). Patients with history of opioid use or history of tobacco use were found to have a lower rate of spontaneous clearance than patients without each history (opioids: 48.6% vs 72.0%, p = 0.02; tobacco: 56.6% vs 80.5%, p = 0.01). Among 43 patients who were diagnosed with chronic hepatitis C, 26 were linked to a clinical setting that can address chronic HCV infection, with linkage to care rate of 60.5%. The most common barrier to this was inability to contact patients after discharge from the ED.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A streamlined EMR system for HCV screening and subsequent linkage to care from the ED can be successfully implemented. A retrospective review suggests that male sex is related to chronic HCV infection, and history of opioid use or history of tobacco use is related to lower HCV spontaneous clearance.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252976","type":"journal-article","created":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T23:48:35Z","timestamp":1623368915000},"page":"e0252976","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Hepatitis C virus screening of high-risk patients in a community hospital emergency department: Retrospective review of patient characteristics and future implications"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8713-8955","authenticated-orcid":true,"given":"Ji Seok","family":"Park","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judy","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hillary","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,10]]},"reference":[{"issue":"5","key":"pone.0252976.ref001","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1002\/hep.27978","article-title":"Toward a more accurate estimate of the prevalence of hepatitis C in the United States","volume":"62","author":"BR Edlin","year":"2015","journal-title":"Hepatology"},{"issue":"27","key":"pone.0252976.ref002","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1056\/NEJM199212313272702","article-title":"The natural history of community-acquired hepatitis C in the United States","volume":"327","author":"MJ Alter","year":"1992","journal-title":"New England journal of medicine"},{"issue":"4","key":"pone.0252976.ref003","first-page":"1","article-title":"Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945\u20131965","volume":"61","author":"BD Smith","year":"2012","journal-title":"Morbidity and Mortality Weekly Report: Recommendations and Reports"},{"issue":"2","key":"pone.0252976.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr6902a1","article-title":"CDC recommendations for hepatitis C screening among adults\u2014United States, 2020","volume":"69","author":"S Schillie","year":"2020","journal-title":"MMWR Recommendations and Reports"},{"issue":"4","key":"pone.0252976.ref005","doi-asserted-by":"crossref","first-page":"296","DOI":"10.7326\/0003-4819-132-4-200002150-00008","article-title":"Pathogenesis, natural history, treatment, and prevention of hepatitis C","volume":"132","author":"TJ Liang","year":"2000","journal-title":"Annals of internal medicine"},{"issue":"3","key":"pone.0252976.ref006","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.cld.2005.05.003","article-title":"Natural history of hepatitis C","volume":"9","author":"DL Thomas","year":"2005","journal-title":"Clinics in liver disease"},{"issue":"6","key":"pone.0252976.ref007","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.amjmed.2018.01.011","article-title":"Cigarette smoking in persons living with hepatitis C: the National health and nutrition examination survey (NHANES), 1999\u20132014","volume":"131","author":"RS Kim","year":"2018","journal-title":"The American journal of medicine"},{"issue":"1","key":"pone.0252976.ref008","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1136\/gut.52.1.126","article-title":"Impact of smoking on histological liver lesions in chronic hepatitis C","volume":"52","author":"C Hezode","year":"2003","journal-title":"Gut"},{"key":"pone.0252976.ref009","unstructured":"Viral Hepatitis Surveillance United States [Internet]. Centers for Disease Control and Prevention. 2017 [cited July 4, 2020]. https:\/\/www.cdc.gov\/hepatitis\/statistics\/2017surveillance\/index.htm."},{"issue":"17","key":"pone.0252976.ref010","first-page":"453","article-title":"Increases in hepatitis C virus infection related to injection drug use among persons aged\u2264 30 years\u2014Kentucky, Tennessee, Virginia, and West Virginia, 2006\u20132012","volume":"64","author":"JE Zibbell","year":"2015","journal-title":"MMWR Morbidity and mortality weekly report"},{"issue":"2\u20133","key":"pone.0252976.ref011","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.drugalcdep.2007.01.003","article-title":"Injecting and sexual risk correlates of HBV and HCV seroprevalence among new drug injectors","volume":"89","author":"A Neaigus","year":"2007","journal-title":"Drug and alcohol dependence"},{"issue":"2","key":"pone.0252976.ref012","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.cgh.2019.04.035","article-title":"Prevalence of spontaneous clearance of hepatitis C virus infection doubled from 1998 to 2017","volume":"18","author":"S Seo","year":"2020","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"pone.0252976.ref013","unstructured":"Hepatitis C, Chronic. 2016 Case Definition [Internet]. Centers for Disease Control and Prevention. 2016 [cited July 4, 2020]. https:\/\/wwwn.cdc.gov\/nndss\/conditions\/hepatitis-c-chronic\/case-definition\/2016\/."},{"issue":"19","key":"pone.0252976.ref014","doi-asserted-by":"crossref","first-page":"569","DOI":"10.15585\/mmwr.mm6919a1","article-title":"High prevalence of hepatitis C infection among adult patients at four urban emergency departments\u2014Birmingham, Oakland, Baltimore, and Boston, 2015\u20132017","volume":"69","author":"JW Galbraith","year":"2020","journal-title":"Morbidity and Mortality Weekly Report"},{"issue":"8","key":"pone.0252976.ref015","doi-asserted-by":"crossref","first-page":"e186371","DOI":"10.1001\/jamanetworkopen.2018.6371","article-title":"Prevalence of hepatitis C virus infection in US states and the District of Columbia, 2013 to 2016","volume":"1","author":"ES Rosenberg","year":"2018","journal-title":"JAMA network open"},{"key":"pone.0252976.ref016","unstructured":"Decision Memo for Screening for Hepatitis C Virus (HCV) in Adults (CAG-00436N) [Internet]. Centers for Medicare & Medicaid Services. 2014 [cited March 6, 2021]. https:\/\/www.cms.gov\/medicare-coverage-database\/details\/nca-decision-memo.aspx?NCAId=272."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252976","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T23:48:58Z","timestamp":1623368938000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252976"}},"subtitle":[],"editor":[{"given":"Jason T.","family":"Blackard","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,10]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0252976","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2021,6,10]]}}}