Hepatitis C virus (HCV) is a communicable disease that could lead to liver cirrhosis and hepatocellular carcinoma affecting baby boomers and all people who inject drugs (PWID) in particular. There are over 19,000 HCV-related deaths in the United States annually. HCV can be cured using direct-acting antivirals that can also reverse HCV-related liver injury. In 2012, the CDC released guidelines encouraging physicians to expand targeted HCV testing to include all baby boomers (persons born between 1945 and 1965) in addition to other high risk groups such as PWID.
To examine the impact of this guideline change on clinical practice, CHERISH mentee Dr. Josh Barocas recently published a study in Health Affairs that compares the rates of HCV testing among the baby boomer population and the population born after 1965 before and after the 2012 guideline change. CHERISH Investigator Dr. Laura White at Boston Medical Center is a co-author. Dr. Barocas’ study used MarketScan Commercial Claims and Encounters data, a nationally representative database of commercially insured patients, from 2010-2014. Although he finds increasing rates of HCV testing across both populations, there was a markedly higher rate of testing in the baby boomer population following the CDC guidelines that was not observed among adults born after 1965. When he expanded the study period to measure rates of testing 24 months following the guidelines he found a sustained increase in testing. The guidelines were released before current highly curative direct-acting antiviral treatment regimens were available, so we do not know how many were subsequently treated with the new regimens.
These findings indicate that the HCV testing policy change resulted in a sustained increase in testing among the target baby boomer population and consequently reduced the impact of the HCV epidemic in the United States. Dr. Barocas comments that a similar initiative may help increase screening in the population of people born after 1965, which includes young PWID who are at high risk for HCV infection but may not be identified by risk-based screening. Dr. Barocas and other CHERISH-affiliated researchers are currently conducting research on the impact expanding CDC testing guidelines to adults born after 1965. Dr. Barocas went on to say “since we have evidence that providers follow HCV testing guidelines, it may be time to expand the reach of those guidelines and routinely test younger adults who, through substance use, are at increased risk of HCV infection.”