Research Articles and Presentations

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This page contains links to research articles and presentations that can be used in making the case for baby boomer hepatitis C screening and linkage to care.

National Reports

Annual Report to the Nation on the Status of Cancer, 1975-2012, Featuring the Increasing Incidence of Liver Cancer
Ryerson et al., 2016
This report, released by CDC, demonstrates that while substantial progress has been made against cancer overall, a rapidly increasing number of Americans are developing and dying from liver cancer. Most alarmingly, the report states that hepatitis B and C are the leading contributing factors to liver cancer in the United States. Hepatitis C related factors contribute to 50% of liver cancer cases in the United States, and hepatitis B related factors contribute to 15% of liver cancer cases.

Surveillance for Viral Hepatitis – United States, 2014
CDC, 2016
CDC released new viral hepatitis surveillance data from 2014 in May of 2016. The reports highlights the alarming death toll of hepatitis C in the United States, the rise in new hepatitis C infections, and the continued public health problem of chronic hepatitis B.


HCV Disease Burden: the Case for Baby Boomer Screening

Impact of an Electronic Health Record Alert in Primary Care on Increasing Hepatitis C Screening and Curative Treatment for Baby Boomers
Konerman, et al, 2017
Despite effective treatment for chronic hepatitis C (CHC), deficiencies in diagnosis and access preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record (EHR) based prompt on HCV screening rates in baby boomers in primary care, and access to specialty care and treatment among those newly diagnosed. 

Hepatitis C Disease Burden in the U.S. in the Era of Oral DAA's
Chhatwal, et al, 2016
Along with recent updates in HCV screening policy and expansions in insurance coverage, the treatment demand in the United States is changing rapidly. Increasing HCV screening and treatment capacity is essential to further decreasing HCV burden in the United States.

Comparison of Hepatitis C Virus Testing Strategies: Birth Cohort Versus Elevated Alanine Aminotransferase Levels
Smith & Yartel, 2014
The birth cohort strategy, which is recommended by both the CDC and the U.S. Preventive Services Task Force, would identify 1 million more anti-HCVþ people than the elevated ALT approach. Concurrent implementation would identify an even larger number of individuals ever infected.

Acting Surgeon General calls for HCV Baby Boomer Screening
Lushniak, 2014
CDC issued a recommendation in 2012 to test all Baby Boomers one time, whether or not a history of risk is elicited. This recommendation enables medical providers to offer HCV testing to baby boomers routinely, without the barrier of discussing stigmatized risk behaviors.

Health Disparities

Disparities in Hepatitis C Testing in U.S. Veterans Born 1945-1965
Sarkar et al., 2016
Analysis of United States Veterans Administration data show significant disparities in Hepatitis C Virus (HCV) testing of veterans born 1945-1965 (birth cohort). A fifth of those not tested had evidence of advanced liver fibrosis. Our data suggests some predictors for this disparity and will potentially help inform future policy measures in the era of universal birth cohort testing for HCV.

Hepatitis B and C in African Americans: Current Status and Continued Challenges
Forde et al., 2014
This literature review illustrates that there are many racial and ethnic disparities in the context of hepatitis B and C infection that have yet to be addressed in the literature. Further understanding of viral hepatitis and the development of cost-effective treatment strategies will lead to eradication of these viral diseases in all, irrespective of race and ethnicity.

HCV Screening and Treatment Delivery

Primary Care

High Efficacy of HCV Treatment by Primary Care Providers: The ASCEND Study
Kattakuzhy  et al, 2016
Limited access to specialists and lack of provider expertise in hepatitis C DAA treatment remain significant barriers in the hepatitis C care cascade. This investigation demonstrates that HCV treatment administered independently by PCPs and NPs is safe and equally effective as care observed with experienced specialists.

Integrating Routine HCV Testing in Primary Care: Lessons Learned from Five Federally Qualified Health Centers in Philadelphia, Pennsylvania, 2012–2014
Coyle et al., 2016
As part of CDC’s Hepatitis Testing and Linkage to Care initiative, the National Nursing Centers Consortium integrated a routine opt-out HCV testing and linkage-to-care model at five federally qualified health centers in Philadelphia, Pennsylvania. Our model successfully integrated HCV testing and linkage to care into routine primary care. This study also identified potential successes and barriers that may be experienced by other primary care health centers that are integrating HCV testing.

Primary Care Physician Perspectives on Hepatitis C Management in the Era of Direct-Acting Antiviral Therapy
Thomson et al., 2016
Although the majority of PCPs are up to date with HCV screening recommendations, few are able to routinely screen in practice. Most PCPs are not up to date with treatment and do not feel comfortable treating HCV. Interventions to overcome screening barriers and expand treatment into primary care settings are needed to maximize access to and use of curative therapies.

Hepatitis C Virus Antibody Positivity and Predictors Among Previously Undiagnosed Adult Primary Care Outpatients
Smith et al., 2015
In outpatient primary care settings, risk-based testing may miss 4 of 5 newly enrolled patients who are antibody positive. Without knowing their status, people with hepatitis C cannot receive further clinical evaluation or antiviral treatment, and are unlikely to benefit from secondary prevention recommendations to limit disease progression and mortality.

Emergency Departments

Hepatitis C Virus Infection in the 1945-1965 Birth Cohort (Baby Boomers) in a Large Urban ED
Waridibo et al., 2016
This cross-sectional study explores baby boomer knowledge of HCV, prevalence of HCV infection, and linkage to care from a large urban ED. Better linkage to care is needed to justify HCV screening in the 1945-1965 birth cohort in this particular ED setting. Linkage to care from the ED is challenging but can potentially be improved with specific measures including simplified screening algorithms and supportive resources.

Unrecognized Chronic Hepatitis C Virus Infection Among Baby Boomers in the Emergency Department
Galbraith et al., 2015
We describe early experience with integrated opt-out HCV antibody (Ab) screening of medically stable baby boomers presenting to an urban academic ED. We observed high prevalence of unrecognized chronic HCV infection in this series of baby boomers presenting to the ED, highlighting the ED as an important venue for high-impact HCV screening and linkage to care.

Hospital: Inpatient Setting

Hospital-Based Hepatitis C Screening of Baby Boomers in a Majority Hispanic South Texas Cohort: Successes and Barriers to Implementation
Taylor et al., 2016
Patients with no HCV diagnosis or prior HCV test received an automated order for HCV antibody tests combined with reflex HCV ribonucleic acid (RNA) polymerase chain reaction. The prevalence of anti-HCV-positive and chronically HCV-infected patients was higher than many Hispanic or non-Hispanic white cohorts. Most Hispanic patients newly diagnosed with chronic HCV had barriers to care for HCV infection that must be overcome if HCV screening is to reduce morbidity and mortality in this population.

High Priority for Hepatitis C Screening in Safety Net Hospitals: Results from a Prospective Cohort of 4582 Hospitalized Baby Boomers
Turner et al., 2015
Low-income populations are disproportionately affected by hepatitis C virus (HCV) infection. In this low-income, hospitalized cohort, 4% of 4582 screened baby boomers were diagnosed with chronic HCV, nearly twice the rate in the community; one-third had noninvasive testing that indicated advanced fibrosis or cirrhosis, which was significantly more likely for Hispanics, those of older age, those with obesity, those with alcohol abuse/dependence, and those who lacked insurance.


Implementation of Baby Boomer Hepatitis C Screening and Linking to Care in Gastroenterology Practices: A Multi-Center Pilot Study
Younossi et al., 2016
The aim of this study was to implement the CDC’s screening recommendations in the unique setting of gastroenterology practices in patients previously unscreened for HCV. Although the prevalence of HCV AB-positive was low in previously unscreened subjects screened in the gastroenterology centers, the linkage to care was very high. Implementation of the Baby Boomer Screening for HCV requires identifying screening environment with high prevalence of individuals with hepatitis C as well as an efficient process of linking them to care.

Cost effectiveness

Cost-effectiveness of hepatitis C treatment for patients in early stages of liver disease - Leidner 2015
Leidner et al., 2015
Immediate treatment of HCV-infected patients with moderate and advanced fibrosis appears to be cost-effective, and immediate treatment of patients with minimal or no fibrosis can be cost-effective as well, particularly when lower treatment costs are assumed.

The Cost-effectiveness, Health Benefits, and Financial Costs of New Antiviral Treatments for Hepatitis C Virus
Rein et al., 2015
New hepatitis C treatments are cost-effective per person treated, but pent up demand for this treatment may create challenges for financing.

Cost-Effectiveness and Budget Impact of Hepatitis C Virus Treatment With Sofosbuvir and Ledipasvir in the United States
Chhatwal et al., 2015
Treatment of HCV is cost-effective in most patients, but additional resources and value-based patient prioritization are needed to manage patients with HCV.

Presentations and Webinars

Strategies to Enhance HCV Testing, Linkage to Care and Treatment
Dr. Trooskin, 2017
This presentation is on linkage to care for people who inject drugs, emphasizing the gaps in Philadelphia’s HCV care cascade and acknowledging successful programs. The talk was delivered by Dr. Stacey Trooskin, MD, PhD, from Philadelphia FIGHT.

Hepatitis C Update
Dr. Trooskin, 2017
This PowerPoint, created by NVHR's medical advisor, Dr. Stacey Trooskin, MD, PhD, outlines the epidemiology of HCV, management of HCV, and challenges with HCV access to care.

Advances in Hepatitis C Identification and Treatment
Dr. Graham, 2015
This PowerPoint, created by Dr. Camilla Graham, MD, BIDMC, further outlines how to implement and extend providers’ knowledge surrounding hepatitis C birth cohort testing for Baby Boomers.

Navigating Hepatitis C: What Patients Need to Know
March 2015
This webinar covered the most important elements patients need to know about screening, access to care, receiving and paying for treatment, and living with hepatitis C.

National Summit on HCV Prevention and Cure—2014
This resource links to all the presentations given at the Viral Hepatitis Action Coalition's National Summit on HCV Prevention and Cure.

HCV Baby Boomer Screening & Linkage to Care Programs
Dr. Graham, 2014
Dr. Camilla Graham gave this presentation at AASLD in 2014 on the importance of screening Baby Boomers for HCV, with examples of key successful programs.

Urgency of Baby Boomer Testing
September 2014
This webinar covered why and how to make the case for the importance and urgency of screening baby boomers for hepatitis C.