Clinical Scorecard: Evaluation of Hepatitis C Screening Practices in the US Veterans Health Administration Following the Universal Screening Recommendations by the United States Preventive Services Task Force

At a Glance

Key Highlights

• 75% of veterans aged 18–79 in VHA care (2021–2023) received HCV antibody screening.
• 5% of those screened were antibody positive, with >95% receiving confirmatory testing.
• Higher odds of testing and positivity observed in veterans with substance use disorders, mental health diagnoses, unstable housing, advanced liver disease, hepatitis B, or HIV.

Guideline-Based Recommendations

Diagnosis

• Screen all adults aged 18–79 at least once for HCV antibody per 2020 USPSTF recommendations.
• Perform confirmatory HCV viral load or genotype testing following a positive antibody test.

Management

• Link diagnosed individuals to direct-acting antiviral therapy for HCV treatment.

Monitoring & Follow-up

• Track screening coverage and confirmatory testing rates within the healthcare system.
• Identify and monitor high-prevalence subgroups to target interventions.

Risks

• Increased risk of HCV infection in veterans with alcohol, opioid, stimulant use disorders, mental health conditions, unstable housing, advanced liver disease, hepatitis B, or HIV.

Patient & Prescribing Data

Veterans aged 18–79 years in VHA care screened for HCV between 2021 and 2023.

High screening uptake and confirmatory testing rates facilitate timely diagnosis and access to effective direct-acting antiviral therapy.

Clinical Best Practices

• Implement universal HCV screening for adults aged 18–79 as per USPSTF guidelines.
• Ensure confirmatory viral load or genotype testing promptly follows positive antibody results.
• Focus additional screening efforts on veterans with substance use disorders, mental health diagnoses, unstable housing, and co-infections (HBV, HIV).
• Utilize electronic medical records to track screening and confirmatory testing performance.
• Leverage comprehensive care models like VHA’s National Viral Hepatitis Program to improve screening and treatment access.

References

• USPSTF Hepatitis C Screening Recommendations
• VHA National Viral Hepatitis Program