TOPLINE

People experiencing homelessness were more likely to accept nontargeted (opt-out) screening for hepatitis C virus (HCV) infection in emergency departments (EDs) than housed individuals and had higher rates of HCV seropositivity and viremia than housed individuals regardless of the screening strategy.

METHODOLOGY

• Researchers performed a secondary analysis of data from the DETECT Hep C Screening Trial — a multicenter, randomized, pragmatic clinical trial — in Denver between 2019 and 2021.
• A total of 67,223 ED visits involving clinically stable adults eligible for HCV testing were included, and the patients were randomly assigned to receive nontargeted (n = 33,626) or targeted (n = 33,597) HCV screening. In the nontargeted group, testing was offered to everyone regardless of the risk for HCV infection, whereas in the targeted group, testing was offered only to patients with at least one risk factor for HCV infection.
• Homelessness was defined using five electronic health record data fields and screening questions included within a homelessness monitoring registry. People were classified as those experiencing homelessness (n = 9153; 13.5% of the nontargeted group and 13.7% of the targeted group) or housed individuals (n = 58,070; 86.4% of the total population).
• The primary outcomes included HCV screening test offer, test acceptance, and the occurrence of HCV seropositivity or viremia among people experiencing homelessness vs housed individuals.
• The secondary outcomes included nonviremic HCV seropositivity, outpatient follow-up, HCV treatment initiation and completion within 18 months after screening, and previous HCV diagnosis or treatment.

TAKEAWAY

• Homelessness was not associated with test offer in either the targeted or nontargeted screening group. In the nontargeted screening group, homelessness was significantly associated with the acceptance of HCV testing (adjusted risk ratio [aRR], 1.31; 95% CI, 1.22-1.41). In the targeted screening group, among patients at a risk for HCV infection who were offered the HCV test, homelessness was not significantly associated with test acceptance.
• In both the nontargeted and targeted screening groups, homelessness was associated with HCV seropositivity (aRR, 2.91; 95% CI, 2.06-4.13 and aRR, 2.07; 95% CI, 1.46-2.93, respectively) and viremia (aRR, 3.33; 95% CI, 2.12-5.24 and aRR, 3.70; 95% CI, 2.14-6.39, respectively).
• Among patients with HCV seropositivity identified through nontargeted screening, 58.3% were experiencing homelessness, whereas among patients with HCV seropositivity identified through targeted screening, 51.3% were experiencing homelessness.
• No significant difference was found between people experiencing homelessness and housed individuals in terms of linkage to outpatient treatment appointments, receipt of HCV treatment, or completion of HCV treatment in either screening group.

IN PRACTICE

"Given both the acceptability of screening among persons experiencing homelessness and the strong association between homelessness and HCV infection observed in this study, offering nontargeted ED-based HCV screening to all persons experiencing homelessness is likely warranted," the authors wrote.

SOURCE 

The study was led by Kathleen M. Joseph, MD, MPH, Denver Health, Denver. It was published online on July 06, 2026, in the Annals of Emergency Medicine. 

LIMITATIONS

The study was limited by its secondary analysis design, potential social desirability and measurement bias, possible misclassification of homelessness due to reliance on electronic health record-based proxy measures, and its single-center setting, which may have limited generalizability.

DISCLOSURES

The study was supported by the National Institute on Drug Abuse, which had no role in the study design, study conduct, data analysis, manuscript preparation, or publication decisions. One author reported receiving honoraria from Clinical Care Options and Integritas Communications. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.