Nontargeted HCV Screening Yields More Diagnoses Than Targeted Approaches

The DETECT Hep C randomized clinical trial revealed that nontargeted screening of patients in 3 urban emergency departments yielded significantly more diagnosis of hepatitis C virus (HCV) than targeted screening based on risk assessment, according to the investigators.

Conducted in EDs in Denver, CO, Baltimore, MD, and Jackson, MS, the trial randomized 147,498 patient visits. Eligible adults (≥18 years) were assigned to either nontargeted screening—offering HCV testing to all patients regardless of risk—or targeted screening, the researchers explained in JAMA.

The results demonstrated that nontargeted screening significantly outperformed targeted screening in identifying new cases of HCV. Among those in the nontargeted group, 13.4% of patients were tested, yielding 154 new diagnoses. In contrast, the targeted group had 6.3% tested, leading to 115 new diagnoses. Statistically, the relative risk (RR) of detecting a new case through nontargeted screening was 1.34 (95% CI, 1.05–1.70; *P* = .02).

Despite the higher diagnostic yield, only 19.5% of the nontargeted group and 24.3% of the targeted group identified with HCV were linked to follow-up care. Even fewer patients initiated direct-acting antiviral (DAA) therapy (15.6% vs 17.4%), completed treatment (12.3% vs 12.2%), or achieved sustained virologic response at 12 weeks (SVR12) (9.1% vs 9.6%).

While nontargeted screening offers superior case detection, the low rates of care engagement and treatment completion suggest that diagnosis alone is insufficient. The study underscores the urgent need for novel care models to bridge the gap from diagnosis to cure in ED populations, the authors concluded.

Reference:

Haukoos JS, Rothman RE, Galbraith JW, et al. Hepatitis C screening in eEmergency departments: The DETECT Hep C randomized clinical trial. JAMA. 2025;334;(6):497-507. doi:10.1001/jama.2025.10563