Gastroenterology
Non-targeted Screening Superior to Targeted Screening for Identifying New HCV Infections
Jul 26, 2025

AT A GLANCE
A new study published in JAMA reveals that using a non-targeted screening approach in the emergency department (ED) may identify more hepatitis C virus (HCV) infections.1
“Identification of individuals with HCV infection is a public health priority. EDs have been a focus of screening efforts, as they serve large numbers of at-risk patients who commonly do not access health care elsewhere. However, the optimal approach to HCV screening in ED settings remains unknown,” explain study authors Haukoos et al., who sought to discern whether non-targeted screening identifies more new diagnoses than targeted screening.
For study purposes, participants were sourced from three urban EDs in Denver, Colorado; Baltimore, Maryland; and Jackson, Mississippi. Participants were randomly assigned to undergo either non-targeted screening, in which HCV testing was offered regardless of risk, or targeted screening, in which testing was offered based on risk assessment. The primary outcome of interest was newly diagnosed HCV infection (RNA-detected), while secondary outcomes included repeat HCV diagnosis; HCV test offer, acceptance, and completion; HCV genotype and fibrosis staging; components of the HCV care continuum; and all-cause mortality through 18 months of follow-up.
According to the authors, a total of 147,498 patient visits were randomized, with 73,847 patients undergoing non-targeted screening, resulting in 9867 (13.4%) being tested for HCV and 154 new HCV diagnoses; separately, 73,651 patients underwent targeted screening and 23,400 (31.8%) were identified to have risk factors for HCV infection, resulting in 4640 (6.3%) patients being tested for HCV and 115 new HCV diagnoses. Accordingly, it was determined that significantly more new diagnoses of HCV infection were identified by non-targeted HCV screening compared to targeted HCV screening.
Meanwhile, among patients newly diagnosed with HCV infection, small proportions from the non-targeted and targeted screening groups were linked to follow-up care (19.5% vs. 24.3%, respectively), initiated direct-acting antiviral (DAA) treatment (15.6% vs 17.4%), completed DAA treatment (12.3% vs 12.2%), and attained sustained virologic response at 12 weeks (SVR12) (9.1% vs 9.6%), respectively.
“In this multicenter randomized clinical trial, a non-targeted screening approach was superior to targeted screening for identifying new HCV infections among patients seen in three urban EDs,” conclude the authors. “The substantial decrease in patients who went from diagnosis to SVR12 highlights an urgent need for innovative models of HCV treatment.”
Reference
1. Haukoos J, Rothman RE, Galbraith JW, et al. Hepatitis C screening in emergency departments: the DETECT Hep C randomized clinical trial (online ahead of print July 9, 2025). JAMA.