Background. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are\nunaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV\nscreening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed\nHCV. Methods. A convenience sample of medically stable patients (less than or equals to 18 years) presenting to a community ED in\nCalgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection\ndrug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing.\nAntibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the\nproportion of new HCV diagnoses in the high-risk population. Results. Of the 999 patients screened by survey, 247 patients\n(24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31\n(12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible\npatients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9-7.4%); all 6 had antibodies detected on confirmatory\nlab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing.\nInterpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate\nof undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC\ntesting. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is\nfeasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.
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