The U.S. Preventive Services Task Force (USPSTF) shifted its stance on screening for hepatitis C virus (HCV) infection(www.uspreventiveservicestaskforce.org) on June 24, recommending that physicians not only routinely screen high-risk adults, but also offer a one-time screening to all adults born between 1945 and 1965. The abrupt change in the language from the USPSTF's Nov. 26 draft recommendation is forcing the AAFP to delay updating its own recommendations so that new evidence pertaining to the "birth-cohort approach" can be reviewed.
According to USPSTF Co-vice Chair and family physician Michael LeFevre, M.D., M.S.P.H., of Columbia, Mo., the task force decided to pursue the birth-cohort recommendation based on public testimony and new evidence.
"We got a lot of public comments (on the draft recommendation), and many of them suggested that risk-based screening would essentially be a greater burden (to those doing the screening) than a birth-cohort approach, at least for that age group," LeFevre told AAFP News Now. "In addition, there were four different studies published in between the completion of the evidence review and the publication of the final recommendation.
- The U.S. Preventive Services Task Force has issued its final recommendations on screening for hepatitis C virus (HCV) infection, proposing routine screening of high-risk adults, as well as a one-time screen for all adults born between 1945 and 1965.
- In August 2012, the CDC formally expanded its HCV screening recommendations to include the birth cohort.
- Currently, the AAFP does not recommend HCV screening for the entire birth cohort.
"In general, the studies showed a stronger link between the treatment of HCV and improved health outcomes. Even though the birth cohort doesn't have as high an incidence of people identified as those identified as high-risk, the downsides seem to be outweighed more significantly by the benefits in the context of an improved link between treatment and outcomes."
Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, the AAFP liaison to the USPSTF, told AAFP News Now that although the Academy is in line with the task force in recommending HCV screening for high-risk adults, including those with any history of intravenous drug use or blood transfusions prior to 1992, it needs to study the cohort research to determine if the new evidence warrants an upgrade.
"We agree (with the USPSTF) in terms of the high-risk portion, but for the age cohort, we were in line with the original draft recommendation, which was a 'C,'" Campos-Outcalt said. In the USPSTF schema, a C grade means the task force recommends selectively offering or providing a service to individual patients based on the physician's professional judgment and patient preferences. "Now that it has been changed to a 'B' recommendation, the AAFP Commission on the Health of the Public and Science (CHPS) is reviewing all of the new data that made the USPSTF change its mind."
According to the task force, three-quarters of people in the United States who are currently infected with HCV are in the 1945-1965 birth cohort. LeFevre said that the task force is now in sync with the CDC, which expanded its screening recommendations in June 2012.
In an editorial(annals.org) published online in the Annals of Internal Medicine, authors said the USPSTF recommendations reflect the strength of the evidence.
"The independently derived yet similar recommendations for HCV testing from the USPSTF and CDC send a clear signal to health care professionals, policymakers, and the public that screening for HCV is effective," the authors wrote. "Now we can focus our efforts on ensuring capacity for the delivery of clinical preventive services that can reduce missed opportunities for HCV diagnosis and linkage to care and treatment."
According to Herb Young, M.D., director of the Health of the Public and Science Division, CHPS should make its recommendations to the Academy's Board of Directors before fall 2013.