Background: Chronic Hepatitis C Virus (HCV) infection affects approximately 3 million Americans. The 1945-1965 birth cohort has the highest prevalence, estimated at 2%. In 2013, the United States Preventive Services Task Force (USPSTF) endorsed screening for HCV in this cohort with the goal of identifying cases and initiating treatment. However, a variety of obstacles to screening are suspected to contribute to low screening rates. This study evaluated the role of the primary care physician in completing recommended screening in an historically underserved community with a high prevalence of HCV.
Methods: Individuals attending an August 2015 health exposition sponsored by the Rodham Institute completed an anonymous survey. The exposition was hosted in an urban setting where the population has historically been predominantly African American; currently 92% of residents identify as such. The survey included questions on demographic information, access to a PCP, insurance status, as well as knowledge of various topics related to Hepatitis C. Responses were excluded if they did not provide information on their history of screening. The university institutional review board approved the study. Statistical analysis was performed using Fisher’s exact test, with significance set at p\u3c0.05.
Results: Ninety five responses were analyzed. Among them were 29 born in the 1945-1965 timeframe. All of members of this cohort reported having a primary physician and 27 (96.4%) had health insurance. Sixteen discussed HCV with their doctor and 12 of them (75.0%) were screened. Thirteen respondents had not discussed HCV; among them, three (23.1%) were tested for the virus. Having a discussion with the primary physician resulted in a significantly higher rate of HCV screening (p=0.0092).
Conclusions: The primary care provider is vital to implementing preventive health recommendations including those related to HCV screening. Our study showed that in a high-prevalence, insured cohort, patients who had discussed HCV with their primary physician were three times more likely to have been screened for the infection. The population studied all had health insurance and a primary care provider, so health care was broadly accessible. The study also suggests that some recent USPSTF guidelines may not have penetrated into community primary care practices as the screening rates were suboptimal