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TOPLINE:

Nontargeted screening in emergency departments (ED) identified significantly more new hepatitis C virus (HCV) infections than targeted screening, according to a randomized trial. Treatment completion rates, however, remained low.

METHODOLOGY:

• Researchers conducted a prospective, multicenter, randomized DETECT HCV trial at three urban EDs in the US, which included 147,498 adult patients (median age, 41 years; 51.5% men) with diverse racial demographics (42.3% Black, 20.9% Hispanic, and 32.2% White) between November 2019 and August 2022.
• Patients were randomly assigned to undergo targeted (49.9%) or nontargeted HCV screening (50.1%).
• The primary outcome was a newly diagnosed HCV infection.
• Secondary outcomes included repeat diagnoses; HCV test offer, acceptance, and completion rates; HCV treatment initiation and completion rates; sustained virologic response at 12 weeks; and 18-month all-cause mortality.

TAKEAWAY:

• Nontargeted screening identified more new HCV diagnoses than targeted screening (154 vs 115; relative risk [RR], 1.34; P = .02).
• In the nontargeted group, 65,693 patients were offered HCV testing, 16,563 accepted testing, and 9867 completed testing, whereas in the targeted group, 20,982 high-risk patients were offered screening, of whom 7116 accepted and 4640 completed testing.
• Of all diagnosed patients, 58 had a repeat HCV diagnosis, 58 had an appointment with an HCV clinician, 44 initiated direct-acting antiviral treatment, 33 completed treatment, 25 achieved a sustained virologic response at 12 weeks, and 13 died within 18 months.
• No differences were observed in the secondary outcomes between the nontargeted and targeted groups.

IN PRACTICE:

"This multicenter randomized clinical trial determined a nontargeted screening approach was superior to targeted screening for identifying new HCV infections among patients seen in three urban EDs," the authors concluded. "The substantial decrease in patients who went from diagnosis to SVR12 [sustained virologic response at 12 weeks] highlights an urgent need for innovative models of HCV treatment."

SOURCE:

The study was led by Jason Haukoos, MD, MSc, Department of Emergency Medicine, Denver Health, Denver. It was published online on July 09, 2025, in JAMA.

LIMITATIONS:

The generalizability of the study outcomes was limited by the inclusion of only three EDs experienced in infectious disease screening. Changes in ED workflows, screening implementation, and the HCV care continuum during the COVID-19 pandemic likely contributed to delays in secondary outcomes. The study was further limited by the exclusion of a large number of ED visits due to high acuity or lack of consent, potential misclassification bias, and the inability to draw clear inferences from the HCV care continuum and secondary outcomes.

DISCLOSURES:

The study was funded by the National Institute on Drug Abuse. Several authors reported receiving grants, consulting fees, or honoraria from AbbVie, the Gilead Sciences FOCUS program, the Baltimore City Health Department, Clinical Care Options, or Integritas.

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