The critical role
of Hepatitis
C screening: Insights from Nurse Administrator Tina Skinner
Motivated Woman interviewed Tina Skinner, HIV/Viral hepatitis counseling, linkage and testing nurse administrator, to learn more about the Hepatitis C virus and the importance of screening. During the interview, Tina discussed the risks, latest advancements in treatment and the critical role of early detection in improving patient outcomes. She emphasized the need for widespread awareness and regular screenings to combat the spread of the virus and protect community health.
MW: Can you explain the importance of Hepatitis C virus (HCV) screening in healthcare settings?
TS: Everyone should know their HCV status, but nearly half of people with HCV are unaware of their status. Approximately 75%–85% percent of people with HCV do not report any symptoms, which is why screening is important. Routine, opt-out screening gives people a chance to know their status, get treated and avoid transmitting HCV to other individuals.
MW: What are the primary risk factors for HCV infection, and who should be targeted for screening?
TS: HCV is a bloodborne virus. The primary risk factor for HCV infection is through unsafe needle practices, such as tattooing and sharing injection drug equipment. Young people 18-40 years of age are experiencing high rates of HCV infection through unsafe injection drug use. The Centers for Disease Control and Prevention (CDC) recommends adults aged 18-79 receive screening for HCV at least once. Individuals with behaviors that put them at higher risk for infection, like sharing needles, should be screened more frequently.
MW: What should a person diagnosed with HCV infection limit or avoid?
TS: Persons recently diagnosed should seek treatment. HCV is a curable disease with 8-12 weeks of medication. Treating HCV will prevent individuals from developing cirrhosis and liver cancer. Persons with HCV should avoid or limit alcohol use, avoid sharing toothbrushes or razors with family members, or any practice in which blood transmission is possible. People who get cured of HCV can live normal lives.
MW: What screening methods are commonly used for detecting HCV, and how accurate are they?
TS: The commonly used methods of detection include antibody testing (antiHCV) and nucleic acid testing (NAT) to detect presence of HCV RNA (qualitative RNA test). Providers should use an FDA-approved HCV antibody test followed by a NAT for HCV RNA test when antibodies are reactive. A reactive antibody test indicates a history of past or current infection. A detectable HCV RNA test result indicates current infection. NAT for detection of HCV RNA should be used among people with suspected HCV exposure within the past 6 months. These tests are extremely accurate. False positive results are rare.
MW: What is the screening process for HCV and its availability in our healthcare system?
TS: The CDC recommends providers complete Hepatitis C screening with a single visit. This means one sample be tested for HCV antibodies and if positive, then HCV RNA testing automatically. This automatic testing streamlines the process and eliminates any additional action on the part of the patient or the provider. These tests are available in health departments, hospitals and private providers.
MW: What are the challenges healthcare providers face in implementing HCV screening programs?
TS: Some of the challenges that healthcare providers may face when implementing HCV screening include lack of awareness of current screening guidelines, time constraints, stigma and discomfort with assessing sexual and social behavioral practices.
MW: How does early detection through screening contribute to improved patient outcomes and reduced healthcare costs?
TS: Early detection and treatment can prevent liver cirrhosis and cancer that can occur after years of chronic infection. Unfortunately, unrecognized HCV infections may quietly damage someone’s liver, which has a huge impact in our society. People with chronic infections who don’t know they’re infected can also spread the infection to other people.
MW: How do you address stigma or misconceptions surrounding HCV screening and diagnosis?
TS: The stigma with HCV is mainly centered in the route of infection through unsafe injection drug use. There should be no stigma or shame in getting tested to know your status and to access treatment. The health department is working to address stigma surrounding HCV by increasing education and
awareness through health education campaigns and provider training. By doing so, this will ultimately assist with normalizing screenings and increasing access to care.
MW: What role do medical professionals play in facilitating HCV screening and linkage to care for patients who test positive?
TS: Medical professionals play a significant role in facilitating linkage to HCV care. Its standard of care is to screen everyone 18-79 for HCV infection. HCV care includes offering routine screening, providing patient education regarding transmission and treatment, connecting patients with resources and assisting patients with receiving treatment.
MW: What are the current recommendations or guidelines regarding the frequency of HCV screening in various patient populations?
TS: In 2020, the CDC released new recommendations for HCV screening. The recommendations include universal screening for all adults 18 years and older should be screened at least once in their lifetime, and pregnant women should be screened during each pregnancy. Also, individuals should be screened based on risks, regardless of age or prevalence, and periodic testing is recommended for those with ongoing risks for HCV.
MW: In your experience, what are the key considerations for ensuring equitable access to HCV screening services for underserved populations?
TS: The public health department is determined to ensure equitable access to services by providing low-cost or free screening in local health clinics and through community-based organizations and partnerships.
MW: Can you discuss any advancements or innovations in HCV screening technology or methods?
TS: Recent advancements include rapid diagnostic testing and point-of-care confirmatory testing. Patients can receive HCV tests results within 30 minutes. Rapid HCV RNA testing is expected in near future.
MW: How do you address patient concerns or fears related to the HCV screening process?
TS: We know that perceptions are in the eyes of the beholder so we can’t control how people feel, but we do want them to know that they are not alone, and this is a curable diagnosis with the proper treatment. Additionally, providers are trained to provide care with respect to a person’s rights to
privacy. This includes addressing providers’ perceptions regarding HCV risks and reducing stigma associated with injection drug use.
MW: Are there any specific challenges or considerations when conducting HCV screening in certain demographic groups, such as pregnant women or individuals with substance use disorders?
TS: Some of the challenges within certain populations include not having state mandates for third trimester pregnancy, providers’ lack of knowledge regarding current screening recommendations and individuals’ fear or hesitation to disclose substance use due to stigma.
MW: What resources or support services are available to patients who test positive for HCV following screening?
TS: There are several resources available for patients who may test positive for HCV. The CDC provides information regarding screening, preventing transmission and treatment. Also, the American Liver Foundation (ALF) has support services for patients and caregivers. The ALF also provides medication assistance information. Patients are encouraged to receive Hepatitis A and Hepatitis B vaccination to prevent additional liver-related complications. Patients should avoid or limit alcohol use, as it can impact their liver health as well. Also, paying for the medication should not be a barrier to care. There are patient assistance programs available to assist with covering the cost of medications.
MW: Are there any emerging trends or areas of research in HCV screening that you find particularly promising or noteworthy?
TS: In the last five years, the public health department has increased screening, linkage to care and treatment programs in the state. Previously, HCV treatment was costly, and restricted medications today are considered more affordable and are easier to access through insurance or patient assistance programs.
Pull quotes:
“The stigma with HCV is mainly centered in the route of infection through unsafe injection drug use. There should be no stigma or shame in getting tested to know your status and to access treatment.”
“The Centers for Disease Control and Prevention (CDC) recommends adults aged 18-79 receive screening for HCV at least once. Individuals with
behaviors that put them at higher risk for infection, like sharing needles, should be screened more frequently.”
Captions for pictures:
Head shot Tina Skinner: Place this picture at the end of the article and use the below content after her picture.
Tina Skinner, RN, has dedicated nearly a decade to public health, contributing her expertise to the South Carolina Department of Health and Environmental Control. In her current role as the HIV/Viral Hepatitis Counseling, Linkage, and Testing Nurse Administrator, Skinner spearheads comprehensive oversight of HIV testing andviralhepatitisinitiativesacrossSouth Carolina.
Feel free to use the other pictures as you see throughout the article, but make sure to include pic1 as one of the pictures that you use.
