Viral RNA Testing in Hepatitis C Antibody–Positive Veterans
published online 22 January 2009.
Background
Chronic hepatitis C virus (HCV) infection affects approximately 1.3% of the U.S. population. As up to 30% of HCV-antibody (anti-HCV)–positive patients have negative HCV ribonucleic acid (RNA), indicating resolution of infection, VA (Veterans Affairs) guidelines recommend RNA testing on all anti-HCV–positive patients. As HCV RNA testing is a prequel to treatment, perceived eligibility for treatment may influence the decision to order an RNA test. This study was designed to determine the patient and healthcare facility factors associated with patient receipt of HCV RNA testing.
Methods
Two logistic regression analyses were conducted in anti-HCV–positive patients, including the entire sample and then on a subsample excluding sites with routine HCV RNA testing policies, using data stored in the VA Southern California Network data warehouse. Significant patient- and site-level predictors of patient receipt of HCV RNA testing were determined.
Results
Of the 13,257 antibody-positive patients, 76% received HCV RNA testing. Excluding sites with routine HCV RNA testing, patients aged >65 years (RR=0.79) and illicit drug users (RR=0.94) were significantly less likely to receive HCV RNA testing. Patients with abnormal transaminases (RR=1.14), presence of non-HCV hepatitis (RR=1.08), or decompensated liver disease (RR=1.22) were significantly more likely to receive HCV RNA testing.
Conclusions
Without policies for routine RNA testing, patients with hepatitic C who either are aged >65 years or are illicit drug users are less likely to be tested. Also, patient receipt of RNA testing becomes dependent on clinical cues of hepatic decompensation or inflammation. The results support the implementation of routine RNA testing for anti-HCV–positive patients.
aRobert Wood Johnson Clinical Scholars Program, University of California at Los Angeles, Los Angeles, California
bCenter for Outcomes Research and Education, University of California at Los Angeles, Los Angeles, California
cDepartment of Internal Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
dVeterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
eDivision of Gastroenterology, University of Southern California, Los Angeles, California
fJohn Cochran VA Medical Center, Saint Louis, Missouri
gDivision of Gastroenterology, Saint Louis University, Saint Louis, Missouri
hDepartment of Internal Medicine, Boston University, Boston, Massachusets
Address correspondence and reprint requests to: Catherine A. Rongey, MD, MSHS, Department of Medicine, GI/Liver Division, USC School of Medicine, 1200 N. State Street, LAC Room 12-137, Los Angeles CA 90033
ABSTRACT