Annual Hepatitis C Virus (HCV) Screening for Patients who are Active Injection Drug Users

Measure Specification

Of the estimated 3.5 million people living in the United States with the hepatitis C virus infection (HCV), only 50% have been tested for HCV and are aware of their status. Reported cases of HCV have increased (approximately 20% per year) between 2010-2016, which is only partially due to improved case detection and more likely due to rising rates of injection drug use.

Additionally, only one third have been referred for HCV care and only 5.6% receive recommended treatment. Studies indicate that even among high-risk patients for whom screening is recommended, only 49-75% are aware of their infection status. In a recent analysis of data from a national health survey, 67.9 % of persons ever infected with HCV reported an exposure risk, (e.

g., injection drug use, having sexual contact with suspected/confirmed hepatitis C patient), 2 weeks to 6 months prior to symptom onset, and the remaining 32.1% reported no known exposure risk. Data from the CDC shows that of the 2016 case reports that had information about drug use, 68.6% reported the use of injection drugs. According to one study, 72% of persons with a history of injection-drug use who are infected with HCV remain unaware of their infection status.

Current risk-based testing strategies have had limited success, as evidenced by the substantial number of HCV-infected persons who remain unaware of their infection. As a result, many do not receive needed care (e.g., education, counseling, and medical monitoring), and are not evaluated for treatment. HCV causes acute infection, which can be characterized by mild to severe illness but is usually asymptomatic.

In approximately 75%-85% of persons, HCV persists as a chronic infection, placing infected persons at risk for liver cirrhosis, hepatocellular carcinoma (HCC), and extrahepatic complications that develop over the decades following onset of infection. Since 1998, routine HCV testing has been recommended by CDC for persons most likely to be infected with HCV.

These recommendations were made on the basis of a known epidemiologic association between a risk factor and acquiring HCV infection, including injection drug use. It is estimated that most new cases of HCV infections are among young persons who are white, live in non-urban areas and have a history of previously reported injection drug use. An epidemic has arisen that is a national priority for federal and state public health agencies.

HCV testing is the first step toward improving health outcomes for persons who report injection drug use and are infected with HCV.

Verbatim from AASLD and IDSA Recommendations for Testing, Managing, and Treating Hepatitis C, September 2017: Annual HCV testing is recommended for persons who inject drugs and for HIV-infected men who have unprotected sex with men. Periodic testing should be offered to other persons with ongoing risk factors for HCV exposure. (Rating: Class IIA, Level C) (AASLD/IDSA, 2017) The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection.

The USPSTF also recommends offering 1-time screening for HCV infection to adults born between 1945 and 1965. (Grade B recommendation) (USPSTF, 2020) Assessment of Risk The most important risk factor for HCV infection is past or current injection drug use. Another established risk factor for HCV infection is receipt of a blood transfusion before 1992.

Because of the implementation of screening programs for donated blood, blood transfusions are no longer an important source of HCV infection. In contrast, 60% of new HCV infections occur in persons who report injection drug use within the past 6 months. Additional risk factors include long-term hemodialysis, being born to an HCV-infected mother, incarceration, intranasal drug use, getting an unregulated tattoo, and other percutaneous exposures (such as in health care workers or from having surgery before the implementation of universal precautions).

Evidence on tattoos and other percutaneous exposures as risk factors for HCV infection is limited. The relative importance of these additional risk factors may differ on the basis of geographic location and other factors.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.