Impact of Point-of-Care Hepatitis C Virus RNA Testing on an Emergency Department Screening Program

Hepatitis C virus (HCV) infection remains a major cause of cirrhosis, hepatocellular carcinoma, transplant, and liver-related mortality. While direct-acting antivirals (DAAs) are highly effective, linkage to care (LTC) after ED-based screening varies widely. Point-of-care (POC) HCV RNA testing can provide real-time diagnosis and counseling, potentially expediting evaluation and treatment. We hypothesized that implementing the Xpert® HCV test (Cepheid, Sunnyvale, CA) in the ED would improve 6-month LTC compared with a standard EMR-based screening program.

We conducted a prospective cohort study of patients undergoing Xpert HCV testing in an urban ED and compared outcomes with a historical cohort identified prior to implementation. Adults aged ≥22 years with HCV antibody positivity, prior undocumented HCV RNA testing, or history of intravenous drug use (IVDU) were included. LTC was defined as attendance at the first visit with an HCV-treating clinician. The primary outcome was LTC at 6 months; secondary outcomes were DAA initiation and 6-month mortality. Groups were compared using Fisher’s exact test. Effect sizes were summarized as risk ratios (RRs) with 95% confidence intervals (CIs).

Forty-seven patients with HCV RNA detected by Xpert HCV were compared with 47 historical controls. LTC at 6 months occurred in 12/47 (25.6%) in the Xpert HCV test cohort versus 6/47 (12.8%) in controls (RR 2.00, 95% CI 0.82–4.88, p=0.19). DAA initiation was uncommon (2/47 vs 1/47; RR 2.00, 95% CI 0.19–21.31, p=1.00). Six-month mortality was 4/47 in each group (RR 1.00, 95% CI 0.27–3.76, p=1.00). IVDU was more frequent in the Xpert HCV test cohort (10/47 [21.3%] vs 2/47 [4.3%], p=0.027).

Implementation of POC HCV RNA testing was associated with higher observed LTC, though this cohort was underpowered to show statistical significance. Xpert HCV testing may support same-day test-and-treat models to improve HCV outcomes. Larger studies with adjustment for key social and clinical factors are needed to determine the independent effect of POC RNA testing on LTC and downstream treatment outcomes.