Hepatitis C Screening Among Persons Experiencing Homelessness in the Emergency Department: A Secondary Analysis of the Determining Effective Testing in Emergency Departments and Care Coordination on Treatment Outcomes (DETECT) for Hepatitis C (Hep C) Screening Trial
Abstract
Study objective: Emergency departments (EDs) are well positioned to screen for hepatitis C virus (HCV), particularly among persons experiencing homelessness who are at increased risk for HCV and are traditionally underserved in health care settings. We examined associations between homelessness and HCV test offer, acceptance, seropositivity, and viremia as part of ED screening.
Methods: We performed a secondary analysis of data from Denver Health Medical Center (Denver, Colorado), one site in the DETECT Hep C Screening Trial, a multicenter randomized pragmatic clinical trial of nontargeted versus targeted screening in EDs. Stratified by the 2 screening strategies, we performed multivariable log binomial regression while adjusting for demographics, clinical severity, arrival method, payor, and, in targeted screening, HCV risk factors.
Results: A total of 67,223 visits were included, with 13.5% persons experiencing homelessness (n=4,539/33,626) in the nontargeted group and 13.7% persons experiencing homelessness (n=4,614/33,597) in the targeted group. Compared to housed patients, persons experiencing homelessness more commonly accepted testing (21.7% [n=895/4,122] versus 15.7% [n=4,044/25,752] in nontargeted and 30.2% [n=540/1,788] versus 23.2% [n=1,600/6,895] in targeted) and were more commonly HCV seropositive (14.2% [n=91/643] versus 2.6% [n=65/2,479] in nontargeted and 17.6% [n=76/432] versus 6.0% [n=72/1,198] in targeted). In multivariable regression, homelessness was not…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 4,614 participants or records.
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