P0705 - Barriers to Hepatitis C Virus Testing According to Latest CDC Recommendations Among Trainees of Internal Medicine and Family Medicine at a Single Tertiary Academic Medical Center

Naren Nallapeta, MD¹, Mary Mikhael, MD¹, Jennie Keum, BS¹, Eric Hilker, BS¹, Emily Xu, BA¹, Ankita Nallani, BA¹, Sydney Sahudin, BS², Ghasssan M. Hammoud, MD, MPH^1
1University of Missouri, Columbia, MO; ²University of Missouri School of Medicine, Columbia, MO

Introduction: Hepatitis C virus (HCV) infection is a major source of morbidity and mortality in the United States. Chronic HCV infections affect approximately 2.4 million Americans. In 2020, the CDC, USPSTF, and AASLD/IDSA recommend one-time opt-out testing for HCV in all

adults aged 18 to 79 years irrespective of risk factors. We sought to measure Internal Medicine (IM) and Family Medicine (FM) residents’ perspective of HCV screening guidelines and barriers to routine testing.

Methods: This survey was conducted at a single tertiary care academic health center comprised of IM and FM training programs. An electronic anonymous 41-question survey was distributed among the trainees between May to June 2021. We received a total of 32 (28.5%) responses out of 112 (70 IM and 42 FM) resident physicians using Redcap distribution tool for obtaining the responses.

Results: Thirty-two (21 IM and 11 FM) surveys were completed. Seventeen (53%) trainees were aware of the current CDC recommendations for HCV testing and less than five (15.6%) residents reported routine testing for HCV based on CDC recommendations. The most common barriers for routine testing were competing priorities (41%), insufficient time (37%) and patient refusal (16%). (figure 1a). The most common facilitators for routine testing were Electronic Medical Records reminders (31%), knowledge about current guidelines (25%), institutional ease of ordering (12.5%) and reminders from attending physicians (12.5%) (Figure 1b). Many of the residents fail to obtain history regarding risk factors for HCV transmission during their encounters (see figure 1c). Majority of the residents strongly agreed to positive statements about HCV screening. (figure 1d). There were no significant differences in the knowledge about HCV screening among internal medicine and family medicine residents in the program. (see table 1)

Discussion: There are gaps in knowledge regarding testing for HCV according to CDC recommendations among IM and FM residents. A small proportion of trainees were performing routine testing. While competing priorities and lack of time remain significant barriers to testing, electronic medical record reminders and knowledge about current guidelines facilitate testing.


Figure: Figure 1 - Results graph representing responses obtained from trainees from Internal Medicine and Family Medicine at a single tertiary medical center

Demographic Characteristics of the Respondent Trainees
Gender	N (%)
Male	14 (43.8)
Female	18 (56.2)
Age
25-29	15 (46.9)
30-35	12 (37.5)
>35	5 (15.6)
Primary specialty
Internal medicine	21 (65.6)
Family medicine	11 (34.4)
Level of training
PGY-1	11 (34.4)
PGY-2	7 (21.9)
PGY-3	9 (28.1)
PGY-4 and above	5 (15.6)

HCV Testing Awareness according to CDC Recommendations among Trainees
	IM (n=21)	FM (n=11)	P-value
Correctly identified most common mode of HCV transmission in the United States	17 (80.9%)	10 (90.9%)	0.63
Correctly identified percentage of HCV-infected unaware of their diagnosis	9 (42.9%)	4 (36.3%)	1
Correctly identified chances of someone with chronic HCV infection developing cirrhosis	10 (47.6%)	3 (27.2%)	0.45
Correctly identified the annual risk of HCC in patients who have HCV related cirrhosis	10 (47.6%)	5 (45.4%)	1
Knew the current CDC guidelines on HCV screening recommendations	11 (52.4%)	6 (54.5%)	1
Family with settings where HCV screening is not recommended in the community	7 (33.3%)	0 (0)	0.06
Knew the awareness of CDC recommendations for universal screening in pregnant women	10 (47.6%)	4 (36.4%)	0.72

Table: Table 1 - Demographic Characteristics of the respondent trainees and HCV Testing awareness among trainees


Disclosures:
Naren Nallapeta indicated no relevant financial relationships.
Mary Mikhael indicated no relevant financial relationships.
Jennie Keum indicated no relevant financial relationships.
Eric Hilker indicated no relevant financial relationships.
Emily Xu indicated no relevant financial relationships.
Ankita Nallani indicated no relevant financial relationships.
Sydney Sahudin indicated no relevant financial relationships.
Ghasssan Hammoud indicated no relevant financial relationships.


Naren Nallapeta, MD¹, Mary Mikhael, MD¹, Jennie Keum, BS¹, Eric Hilker, BS¹, Emily Xu, BA¹, Ankita Nallani, BA¹, Sydney Sahudin, BS², Ghasssan M. Hammoud, MD, MPH¹. P0705 - Barriers to Hepatitis C Virus Testing According to Latest CDC Recommendations Among Trainees of Internal Medicine and Family Medicine at a Single Tertiary Academic Medical Center, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.