Table 4.

Integrated screening programs at VA clinics

Program characteristics									Program outcomes
First author, year of publication	Calendar year of data collection	Population	Country and HCV prevalence according to CDC[23]	Setting of screening	Duration of screening program	Other tests	Prescreening selection	Media activities	Screening uptake and anti-HCV prevalence (95% CI)	Risk profile of identified HCV cases/Risk factors associated with HCV	Follow-up of HCV-infected individuals
Groom et al. 2008 [79]	2000-2001	Veterans	USA (1.9%): Minneapolis	Veteran Affairs clinic	2 years	None	Yes, only those with a risk factor were screened (risk factors not specified)	NR	Scr. uptake: NR	NR	In total, 520/681 were HCV RNA positive of which 430 referred to a specialist, of which 88.8% (382/430) attended an appointment. Of those, 32.5% (124/382) received treatment which was successful in 37.0% (46/124) (SVR).
									Prevalence: 5.5% (681/12485; 95% CI: 5.1-5.9)*
											Outcomes: RNA rate: 76.4% (520/681) Start treatment: 32.5% (124/382) SVR: 37.1% (46/124)
Mallette et al. 2008 [80]	1998-2004	Veterans	USA (1.9%): Providence	GP patients presenting to VA clinics	5 years and 8 months	None	Yes, only those with a risk factor were screeneda	NR	Scr. uptake: 66.7% (5646/8471) Prevalence: 7.3% (412/5646; 95% CI: 6.6-8.0); without already known positives: 260/5646 = 4.6% (95% CI = 4.1-5.2%)***	Listed risk factors: - History of IDU - Blood transfusion before 1992 - Intranasal cocaine use - Multiple sex partners - Tattoos	Of the newly diagnosed, 46.9% (122/260) had chronic HCV, of which 46.7% (57/122) were treatment eligible. Of those, 31.6% (18/57) received treatment and 33.3% (6/18) reached an SVR. Outcomes: RNA rate: 46.9% (122/260) Start treatment: 14.8% (18/122) SVR: 33.3% (6/18)
Cheung et al. 2006 [81]	2000-2001	Veterans	USA (1.9%): Palo Alto	VA clinic	12 months	None	Yes, if not previously tested, and if one or more risk factors were reportedb	NR	Scr. uptake: NR	NR	In total, 362/536 patients were evaluated of which 84.8% (307/362) had chronic HCV. Of those, 18.6% (57/307) were treatment eligible of whom 24.6% (14/57) completed treatment with long-term follow-up, and 35.7% (5/14) achieved SVR.
									Prevalence: 5.0% (536/10751; 95% CI: 4.6-5.4)***
											Outcomes: RNA rate: 84.8% (307/362) Start treatment: NR SVR: 35.7% (5/14)
Rifai et al. 2006 [82]	2000-2001	Veterans	USA (1.9%): Virginia	Rural VA clinic	22 months	None	Yes, only non-IDU substance using veterans who were admitted to a substance-use residential and rehabilitation treatment program were tested	NR	Scr. uptake: 99.4% (338/340) Prevalence: 23.1% CHCV (78/338; 95% CI: 18.9-27.9) (incl. 2 who knew already)****	Univariate regr. analysis: - Cocaine snorting - History of IDU	In total, 48.7% (38/78) of the patients remained abstinent for 6 months and 30 were indicated for treatment and received treatment. In 46.7% (14/30) treatment was successful (SVR).
											Outcomes: RNA rate: n/a Start treatment: 81.1% (30/37) SVR: 46.7% (14/30)
Zuniga et al. 2006 (abstract) [83]	2001-2003	Veterans	USA (1.9%): Suffolk County, Long Island	Primary-care outpatient departments of the Northport VA clinic (suburban VA hospital)	27 months	None	Yes, only those with a risk factor were screenedc	No	Scr. uptake: 41.9% (2263/5400) Prevalence: 4.6% CHCV (103/2263; 95% CI: 3.8-5.5)****	Multivariable regr. analysis - Age 40–54 yrs - Black race - History of IDU - Service during Vietnam era - Blood transfusion prior to 1992 - Tattoo or repeated body piercing - History of abnormal LFTs	NR Outcomes: RNA rate: n/a Start treatment: NR SVR: NR

Note: CI = confidence interval; NR = not reported; VA = veterans affairs; IDU = injecting drug use; HCV = hepatitis C virus; CHCV = chronic hepatitis C virus; HIV = human immunodeficiency virus; LFT = liver function test; SVR = sustained virological response; PCR = polymerase chain reaction.

*HCV-antibody prevalence is considered suboptimal (data were collected before 1994 when sensitivity/specificity of tests was not optimal, or reactive HCV-antibody test results were not confirmed by immunoblot).

***HCV-antibody prevalence is considered valid; data were collected after 1993, and reactive HCV-antibody test results were confirmed by second or higher generation immunoblot assays from Ortho, Chiron, Novartis (RIBA), Innogenetics (LiaTek), Pasteur (DECISCAN HCV), Genelabs Diagnostics (HCV BLOT), or Mikrogen (recomBlot HCV IgG 2.0).

****HCV-antibody prevalence is considered valid, but reflecting chronic HCV infection (data were collected after 1993, and reactive HCV antibody test results were confirmed by PCR).

^aVietnam-era veteran, transfusion of blood of blood products before 1992, history of IDU, history of snorting cocaine, history of 5 or more drinks a day for 10 or more years in your lifetime, history of multiple (10 or more) sexual partners in your lifetime, a man who has sex with men, history of exposure to blood on skin or mucous membranes, required chronic hemodialysis, have a tattoo or body piercing, have had a positive test for HIV or hepatitis B, have been told that you have unexplained liver disease.

^bBlood transfusion prior to 1992, IV drug use (even once), snorting of cocaine, blood exposure, sexual promiscuity (>10 lifetime sex partners), renal dialysis, tattoo or body piercing, excessive alcohol use.

^cVietnam-era veteran, transfusion of blood products prior to 1992, history of IDU, blood exposure in or through skin or mucous membranes, multiple sexual partners (past or present), hemodialysis, tattoo or repeated body piercing, intranasal cocaine use (past or present), unexplained liver disease, having been told that he/she has abnormal liver function tests, intemperate alcohol use (more than seven alcoholic beverages per week).