Clinical Report: Hepatitis C Screening in US Veterans Health Administration Post-USPSTF Guidelines

Overview

From 2021 to 2023, 75% of veterans aged 18–79 in VHA care received hepatitis C virus (HCV) screening, with 5% testing antibody positive and over 95% of those receiving confirmatory testing. Veterans with substance use disorders, mental health diagnoses, unstable housing, advanced liver disease, hepatitis B, or HIV had significantly higher odds of both testing and positivity.

Background

Hepatitis C virus (HCV) infection is a major risk factor for advanced liver disease and mortality, but effective direct-acting antiviral therapies are available for those diagnosed. The United States Preventive Services Task Force (USPSTF) expanded HCV screening recommendations in 2020 to include all adults aged 18–79 years. The Veterans Health Administration (VHA) has a higher HCV seroprevalence than the general population, particularly in the 1945–1965 birth cohort, and has implemented extensive screening programs to identify and treat infected veterans.

Data Highlights

Key Findings

• Three-quarters of veterans aged 18–79 in VHA care were screened for HCV between 2021 and 2023.
• Among those screened, 5% tested positive for HCV antibodies.
• Over 95% of veterans with a positive antibody test received confirmatory viral load or genotype testing.
• Veterans with alcohol, opioid, or stimulant use disorders had significantly higher odds of both receiving HCV testing and testing positive.
• Mental health diagnoses, unstable housing, advanced liver disease, hepatitis B, and HIV infection were also associated with increased HCV testing and positivity.
• The VHA’s comprehensive screening approach aligns with USPSTF recommendations and identifies emerging high-prevalence groups for targeted interventions.

Clinical Implications

The VHA’s success in screening a large majority of veterans and ensuring confirmatory testing demonstrates the feasibility of universal HCV screening in a large healthcare system. Clinicians should prioritize screening in veterans with substance use disorders, mental health conditions, unstable housing, and co-infections to optimize diagnosis and linkage to care. This model may inform other health systems aiming to implement population-based HCV screening and treatment.

Conclusion

The VHA has effectively implemented universal HCV screening consistent with USPSTF guidelines, achieving high testing and confirmatory rates among veterans in care. Targeted efforts toward high-risk groups can further enhance detection and treatment outcomes.

References

1. VHA National Viral Hepatitis Program 2024 -- Evaluation of Hepatitis C Screening Practices in US Veterans Health Administration