Written by Shannon Markus
Spoon Feed
Non-targeted hepatitis C screening in the ED (free regardless of risk) identified more new hepatitis C diagnoses than targeted screening; however, while this found more new cases, it did not translate to increases in successful treatment.
DETECT Hep C in the ED
This large, multi-center, pragmatic RCT compared non-targeted vs. targeted HCV screening across 3 high-volume American EDs. In non-targeted screening, all eligible patients were offered free, voluntary, rapid HCV testing—regardless of risk—during ED triage. Targeted HCV screening involved implementation of risk-based HCV screening using the following criteria: born between 1945 and 1965, IV or IN drug use, tattoo/piercing in unregulated setting, or transfusion or transplant before 1992.
Among ~147,500 randomized ED visits, non-targeted screening led to significantly higher testing rates (13.4% vs. 6.3%) and identified more new HCV cases (RR 1.34, 95%CI 1.05–1.70; P = .02). Despite broader reach, downstream care linkage and treatment rates remained low in both groups, with only ~9% of newly diagnosed patients in each group achieving sustained virologic response. The study had a few big limitations. First, patients with recent IVDU (a very high-risk population) were less likely to engage in testing or treatment, and a large portion of all high-risk patients still chose to opt out. While non-targeted screening aligns with CDC and USPSTF recommendations and improves case identification, the trial underscores the gap from diagnosis to cure and highlights the need for ED HCV screening programs to be paired with linkage strategies (like care navigators, immediate antiviral initiation, etc.) to improve population level outcomes.
How does this change my practice?
I personally haven’t been routinely screening for hepatitis C in the ED unless a patient’s presentation suggests viral hepatitis or liver failure, but this study makes a compelling case for non-risk-based HCV screening. However, it also highlights an important limitation…screening alone doesn’t translate to cure! Far from it. My takeaway is that while non-targeted screening can be beneficial (especially in high-prevalence settings), success depends on coupling screening with reliable care coordination. Ultimately, the role of universal screening depends heavily on your population’s baseline HCV prevalence, and I’d be interested in understanding how these findings apply to the population I currently serve.
Source
Hepatitis C Screening in Emergency Departments: The DETECT Hep C Randomized Clinical Trial. JAMA. 2025 Jul 9:e2510563. doi: 10.1001/jama.2025.10563. Epub ahead of print. PMID: 40632510
