A Wayne State University School of Medicine physician-researcher is using a successful rapid HIV-testing program to serve as a springboard to develop hepatitis C screening for patients entering the Detroit Receiving Hospital emergency department.

Through a partnership with Gilead FOCUS, a branch of the biopharmaceutical company Gilead Sciences Inc., Phillip Levy, M.D., M.P.H., professor of Emergency Medicine and associate chair for Research in the WSU Department of Emergency Medicine, is expanding an existing rapid HIV testing program at Detroit Receiving Hospital to include hepatitis C screening, and transition it from dedicated testing of all emergency room patients to lab-based, integrated testing.

Thanks to the project lead, Bethany Foster, M.P.H., the research assistant who built the successful HIV testing program now in place, the infrastructure for hepatitis C, or HCV, screening already exists. The expanded program, Dr. Levy said, will test patients in the birth cohort (born between 1945 and 1965) targeted by the U.S. Centers for Disease Control and Prevention  we well as those at high risk for hepatitis through a dual approach - one for those receiving a blood draw in the general emergency department and one for patients not receiving a blood draw in Urgent Care.

"Through our partnership with FOCUS we hope to be able to support lab-based testing for some uninsured patients whose testing cannot be reimbursed, and rapid tests for patients in the Urgent Care area," Dr. Levy said.

Hepatitis C is a liver infection caused by the hepatitis C virus, a blood-borne infection. According to the CDC, most people become infected with HVC by sharing needles or other equipment to inject drugs. The illness can be short term for some, but between 70 percent and 85 percent of those who become infected, HCV develops into a long-term, chronic infection. A majority of people may not be aware they are infected, and can be infected for years without knowing it. The virus can lead to cirrhosis, liver failure and liver cancer. There is no vaccine to prevent HCV infection.

The CDC puts the number of acute cases of HCV in the U.S., at about 3.5 million, most of them born between 1945 and 1965. The center estimated approximately 29,718 cases occurred in 2013, the last year for which figures were available.

Within the first three months of the partnership, Detroit Receiving's electronic medical records system will be programmed to more efficiently identify which patients to test. Based on the new EMR prompts, nursing staff will offer HIV testing - due to the opt-in law requirement - and conduct HCV testing with patients. Physicians will place orders for the Hepatitis C Antibody with Quantitative PCR RNA Reflex, and patients with a positive rapid HCV Ab test will have the PCR RNA ordered.

Project assistants will offer community resources such as harm-reduction information, make appointments at partner clinics and work in partnership with two linkage specialists from Community Health Awareness Group to provide additional care services for those patients hardest to link to care.

The project will determine the effectiveness of HCV testing within an emergency department, measure the effectiveness of an emergency department-based HCV linkage-to-care model, provide a model of transitioning from dedicated testing to an integrated screening model for HIV and HCV for Michigan, and provide a post-test algorithm model for addressing the needs of HIV-negative patients in Michigan.

Dr. Levy said he hopes at least 65 percent of eligible patients will agree to be tested for HCV during a visit to the emergency room. He also wants at least 60 percent of those who test positive for HCV or who have a history of untreated HCV to attend their first clinical appointment within 90 days, and hopes at least 60 percent of those patients who are scheduled for a follow-up appointment attend a second clinical visit.

By April, he said, he plans to establish an algorithm capable of identifying eligible patients that prompts a testing alert and possibly populates a lab order. That would be followed by lab-based screening for all patients in the general emergency room and rapid testing only of patients in the urgent care unit who otherwise would receive no blood draw.

Patients who test negative for HIV will be assessed for comprehensive prevention eligibility and appropriateness to be referred as necessary for follow-up. Those who come to the emergency room for a sexual assault exam and who test negative for HIV will be assessed for non-occupational post-exposure prophylaxis. An automated EMR alert based on a patient's risk profile will prompt inclusion of discharge instructions related to at-risk reduction and the need for clinical follow up.