Hepatitis C Screening in Emergency Departments: The DETECT Hep C Randomized Clinical Trial
Abstract
Importance
Identification of individuals with hepatitis C virus (HCV) infection is a public health priority. Emergency departments (EDs) have been a focus of screening efforts, as they serve large numbers of at-risk patients who commonly do not access health care elsewhere. However, the optimal approach to HCV screening in ED settings remains unknown.
Objective
To evaluate the effectiveness of HCV screening in EDs with the hypothesis that nontargeted screening identifies more new diagnoses than targeted screening.
Design, Setting, and Participants
Prospective, multicenter, pragmatic randomized clinical trial performed at 3 urban EDs in Denver, Colorado; Baltimore, Maryland; and Jackson, Mississippi. Patients were 18 years or older, with exclusions for critical illness, inability to provide consent, or previously diagnosed HCV.
Interventions
As part of routine ED care, patients were randomly assigned to undergo either nontargeted screening, in which HCV testing was offered regardless of risk, or targeted screening, in which testing was offered based on risk assessment.
Main Outcomes and Measures
The primary outcome was newly diagnosed HCV infection (RNA detected). Secondary outcomes were repeat HCV diagnoses; HCV test offer, acceptance, and completion; HCV genotype and fibrosis staging; components of the HCV care continuum; and all-cause mortality through 18 months of follow-up. Analyses were conducted from January to March 2025 by intention-to-treat analysis, using relative…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 73 participants or records.
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