A review of the patient education required to empower the patients in understanding who needs annual screening.
Christian B. Ramers, MD, MPH, AAHIVS: You mentioned the overlap between substance-use disorder and hepatitis C. We clearly see these 2 as syndemics, and that's a very rich place to be screening. Caroline, if I can get you to comment. Let's say you screen somebody who tells you that they used drug and they come up negative. Does that mean you're done?
Caroline Derrick, PharmD, BCPS: No, screening is not a one-and-done test. There's a window period, so depending on what test you're using to screen, if you're just using an antibody and they're telling you that they're an active user, maybe you need to be conscious of that window period and order a viral load.
Then education with screening is important because not everyone wears a sign that says, "I'm high risk. Screen me now." A lot of times it's a discussion, getting them to open up, and then appropriately screen patients. Now everyone should be screened, so it's not just high-risk or this person or that person. We really need to kind of come together, screen everyone, and try to appropriately treat everyone. Because the treatment is good and the SVR [sustained virologic response] rates are high, so we can do that now.
Bhavesh Shah, RPh, BCOP: I'd like to add something to that. One of the other complexities of rescreening patients is that our electronic medical records are not set up to actually prompt you. Patients who aren't screened, we have this BOA [bisphenol A] that says this patient should be screened or somebody who should be rescreened. We don't have that standardized, so that's also a limitation.
Christian B. Ramers, MD, MPH, AAHIVS: Let's just be clear about which populations are going to need repeat screening on an annual basis, Caroline.
Caroline Derrick, PharmD, BCPS: We're going to screen those at risk annually, which often includes IV [intravenous] drug users, HIV patients, and men who have sex with men. Those are our high-risk groups that we want to make sure we are screening on an annual basis for their risk to be re-exposed during that year.
Christian B. Ramers, MD, MPH, AAHIVS: Let's say somebody is a high-risk patient who uses drugs and they come in and get treated and cured for their hepatitis C. Should you still rescreen them on an annual basis after? If so, how are you going to do that?
Caroline Derrick, PharmD, BCPS: It depends on their risk of exposure. If they're treated and cured and they're still partaking in high-risk activities, then we should be rescreening them. Because being treated and cured and gaining that antibody that they have, does not necessarily mean, as we said earlier, that they're not at risk for reinfection. They can be reinfected, and we need to monitor for relapse as well. There are a lot of other things that come into that. Rescreening would be important.
Christian B. Ramers, MD, MPH, AAHIVS: Chris, in the situation I just outlined, which test would you send on an annual basis?
Christopher Hulstein, PharmD, CSP: We actually typically do the ELISA [enzyme-linked immunosorbent assay] for the antibody for the initial screen, but because we know the antibody is going to be positive in any patient who was previously exposed to hepatitis C, you do need to get an RNA viral load or an RNA quant. Some people refer to it as that. That's going to be telling you whether a patient actually does have an infection, because that antibody will be positive for the rest of the patient's life.