Original Article

Awareness of Birth Cohort Hepatitis C Testing Recommendation Among Baby Boomers: An Exploratory Survey Study

Authors: Vabhave Pal, MD, Yasir Ahmed, MD, Shikha Singh, MD, Kalpana Bhairavarasu, MD, Lavi Oud, MD

Abstract

Objectives: To examine population awareness of the Centers for Disease Control and Prevention’s (CDC) hepatitis C virus (HCV) testing recommendation for the 1945 to 1965 birth cohort and explore the factors associated with awareness of the testing recommendation, its association with HCV testing, and respondents’ data sources about the recommendation.

Methods: A cross-sectional survey was conducted to assess awareness of the CDC birth cohort testing recommendation among adults born 1945–1965 who were managed at a single academic center’s internal medicine clinics or by visiting a local health fair. Data were collected on respondents’ demographics and HCV-related domains, including risk factors, awareness, data sources, prior testing, and interest in information about testing.

Results: There were a total of 563 respondents to the survey. Forty percent were aware of the CDC’s testing recommendation, with Hispanic ethnicity being the only significant predictor (odds ratio 0.59, 95% confidence interval 0.38–0.90). HCV testing rates were higher among those aware of the CDC’s recommendation, as compared with those unaware (33.6% vs 24.0%, P = 0.0269). Television was the most common initial data source for the testing recommendation (64.8%), whereas healthcare providers accounted for 22.4%.

Conclusions: Awareness of the CDC’s testing recommendation was reported in fewer than half of the respondents and was adversely affected by minority status. Although mass media may be a key venue for HCV-related data outreach, further studies are needed on interventions to enhance the role played by healthcare providers.
Posted in: Gastroenterology53

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Edlin BR, Eckhardt BJ, Shu MA, et al. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology 2015;62:1353-1363.
2. Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med 2014;160:293-300.
3. Ly KN, Xing J, Klevens RM, et al. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med 2012;156:271-278.
4. Southern WN, Norton B, Steinman M, et al. A birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks: a cross-sectional study. BMC Infect Dis 2015;15:553.
5. Smith BD, Yartel AK. Comparison of hepatitis C virus testing strategies: birth cohort versus elevated alanine aminotransferase levels. Am J Prev Med 2014;47:233-241.
6. Patel RC, Vellozzi C, Smith BD. Results of hepatitis C birth-cohort testing and linkage to care in selected U.S. sites, 2012-2014. Public Health Rep 2016;131(suppl 2):12-19.
7. Rein DB, Smith BD, Wittenborn JS, et al. The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings. Ann Intern Med 2012;156:263-270.
8. McGarry LJ, Pawar VS, Panchmatia HR, et al. Economic model of a birth cohort screening program for hepatitis C virus. Hepatology 2012;55:1344-1355.
9. McEwan P, Ward T, Yuan Y, et al. The impact of timing and prioritization on the cost-effectiveness of birth cohort testing and treatment for hepatitis C virus in the United States. Hepatology 2013;58:54-64.
10. Smith BD, Morgan RL, Beckett GA, et al. Hepatitis C virus testing of persons born during 1945-1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med 2012;157:817-822.
11. Almario CV, Vega M, Trooskin SB, et al. Examining hepatitis C virus testing practices in primary care clinics. J Viral Hepat 2012;19:e163-e169.
12. Roblin DW, Smith BD, Weinbaum CM, et al. HCV screening practices and prevalence in an MCO, 2000-2007. Am J Manag Care 2011;17:548-555.
13. Shehab TM, Orrego M, Chunduri R, et al. Identification and management of hepatitis C patients in primary care clinics. Am J Gastroenterol 2003;98:639-644.
14. Shehab TM, Sonnad SS, Lok AS. Management of hepatitis C patients by primary care physicians in the USA: results of a national survey. J Viral Hepat 2001;8:377-383.
15. Southern WN, Drainoni ML, Smith BD, et al. Physician nonadherence with a hepatitis C screening program. Qual Manag Health Care 2014;23:1-9.
16. Linas BP, Hu H, Barter DM, et al. Hepatitis C screening trends in a large integrated health system. Am J Med 2014;127:398-405.
17. Denniston MM, Klevens RM, McQuillan GM, et al. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001-2008. Hepatology 2012;55:1652-1661.
18. Younossi ZM, Stepanova M, Afendy M, et al. Knowledge about infection is the only predictor of treatment in patients with chronic hepatitis C. J Viral Hepat 2013;20:550-555.
19. Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, et al. Oral direct-acting agent therapy for hepatitis C virus infection: a systematic review. Ann Intern Med 2017;166:637-648.
20. Mitchell AE, Colvin HM, Palmer Beasley R. Institute of Medicine recommendations for the prevention and control of hepatitis B and C. Hepatology 2010;51:729-733.
21. US Census Bureau. QuickFacts Ector County, Texas. https://www.census.gov/quickfacts/fact/table/ectorcountytexas/PST045217. Accessed September 21, 2018.
22. Taylor VM, Choe JH, Yasui Y, et al. Hepatitis B awareness, testing, and knowledge among Vietnamese American men and women. J Community Health 2005;30:477-490.
23. White A, Thompson TD, White MC, et al. Cancer screening test use-United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:201-206.
24. Trooskin SB, Navarro VJ, Winn RJ, et al. Hepatitis C risk assessment, testing and referral for treatment in urban primary care: role of race and ethnicity. World J Gastroenterol 2007;13:1074-1078.
25. El-Serag HB, Kramer J, Duan Z, et al. Racial differences in the progression to cirrhosis and hepatocellular carcinoma in HCV-infected veterans. Am J Gastroenterol 2014;109:1427-1435.
26. Le AK, Zhao C, Hoang JK, et al. Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response. Aliment Pharmacol Ther 2017;46:605-616.
27. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282:1458-1465.
28. Kallman JB, Arsalla A, Park V, et al. Screening for hepatitis B, C and non-alcoholic fatty liver disease: a survey of community-based physicians. Aliment Pharmacol Ther 2009;29:1019-1024.
29. Coppola AG, Karakousis PC, Metz DC, et al. Hepatitis C knowledge among primary care residents: is our teaching adequate for the times? Am J Gastroenterol 2004;99:1720-1725.
30. Federman AD, Kil N, Kannry J, et al. An electronic health record-based intervention to promote hepatitis C virus testing among adults born between 1945 and 1965: a cluster-randomized trial. Med Care 2017;55:590-597.
31. Sidlow R, Msaouel P. Improving hepatitis C virus screening rates in primary care: a targeted intervention using the electronic health record. J Healthc Qual 2015;37:319-323.
32. Shahnazarian V, Karu E, Mehta P. Hepatitis C: improving the quality of screening in a community hospital by implementing an electronic medical record intervention. BMJ Qual Improv Rep 2015;4:u208549.w3409.
33. Flanigan CA, Leung SJ, Rowe KA, et al. Evaluation of the impact of mandating health care providers to offer hepatitis C virus screening to all persons born during 1945-1965-New York, 2014. MMWR Morb Mortal Wkly Rep 2017;66:1023-1026.
34. Pew Research Center. Social media fact sheet. http://www.pewinternet.org/fact-sheet/social-media. Updated February 5, 2018. Accessed September 21, 2018.
35. Jorgensen C, Carnes CA, Downs A."Know More Hepatitis:"CDC' national education campaign to increase hepatitis C testing among people born between 1945 and 1965. Public Health Rep 2016;131(suppl 2):29-34.
36. Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet 2010;376:1261-1271.
37. Allison WE, Chiang W, Rubin A, et al. Knowledge about hepatitis C virus infection and acceptability of testing in the 1945-1965 birth cohort (baby boomers) presenting to a large urban emergency department: a pilot study. J Emerg Med 2016;50:825-831.e2.