Missed opportunities for universal hepatitis C screening in a predominantly hispanic safety-net popaulation: a retrospective cohort study
4 affiliations
- 1University of Texas Rio Grande Valley School of Medicine, 1214 W. Schunior St, Edinburg, TX 78541 USA
- 2John H. Stroger Jr. Hospital of Cook County, Chicago, IL USA
- 3Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY USA
- 4University of Illinois College of Medicine, Peoria, IL USA
Abstract
Background: Universal hepatitis C virus (HCV) screening is recommended for all adults in the US, but its implementation in primary care is inconsistent. We evaluated screening rates and missed opportunities in a large, predominantly Hispanic, safety-net primary care population.
Methods: We conducted a retrospective cohort study of adults aged ≥ 18 years who received care at University of Texas Rio Grande Valley–affiliated clinics between November 1, 2023, and October 31, 2024. HCV screening completion was defined as an antibody test with laboratory results and, when the antibody test was positive, reflex RNA testing. Missed opportunity was defined as remaining unscreened despite ≥ 2 primary care encounters. Multivariable logistic regression was used to identify independent predictors of screening completion and missed opportunities.
Results: Among 7,592 eligible patients, only 568 (7.5%) completed screening. Almost two-thirds (65.5%) had ≥ 2 visits, of whom 90.0% (4,477/4,974) remained unscreened, representing 59.0% of the total cohort. Screening increased with visit frequency but remained low overall (2.7% with 1 visit vs. 12.1% with ≥ 4 visits). In multivariable analysis, Spanish-language preference (aOR 1.78; 95% CI 1.44–2.20) and public insurance (aOR 1.79; 95% CI 1.39–2.31) were strongly associated with screening completion. Each additional visit increased screening odds (aOR 1.16; 95% CI 1.13–1.19), yet screening remained below 13% even among patients with ≥ 4 visits.
Conclusions: HCV screening rates were significantly low despite frequent healthcare visits, with many missed opportunities in this safety-net population. System-level factors, rather than patient characteristics alone, appear to drive screening gaps. Automating screening and reducing reliance on visit-based clinician decisions are essential for increasing uptake and advancing HCV elimination efforts.
Clinical trial number: Not applicable.
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BibTeX
@article{lawal2026missed,
title = {{Missed opportunities for universal hepatitis C screening in a predominantly hispanic safety-net popaulation: a retrospective cohort study}},
author = {Ridwan A. Lawal and Cherechi O. Nwabueze and Larry Hill and Bright C. Nwatamole and Nida Asif and Oladoyin Jolaoye and Martha Solis and Aramide Tijani and Daniela Hernandez and Fatimah Bello and Chelsea Chang and Juliana Yang},
journal = {BMC Infectious Diseases},
year = {2026},
month = aug,
doi = {10.1186/s12879-026-14130-8},
url = {https://doi.org/10.1186/s12879-026-14130-8},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Missed opportunities for universal hepatitis C screening in a predominantly hispanic safety-net popaulation: a retrospective cohort study
AU - Ridwan A. Lawal
AU - Cherechi O. Nwabueze
AU - Larry Hill
AU - Bright C. Nwatamole
AU - Nida Asif
AU - Oladoyin Jolaoye
AU - Martha Solis
AU - Aramide Tijani
AU - Daniela Hernandez
AU - Fatimah Bello
AU - Chelsea Chang
AU - Juliana Yang
PY - 2026
DA - 2026/08/06
JO - BMC Infectious Diseases
DO - 10.1186/s12879-026-14130-8
UR - https://doi.org/10.1186/s12879-026-14130-8
AB - Background: Universal hepatitis C virus (HCV) screening is recommended for all adults in the US, but its implementation in primary care is inconsistent. We evaluated screening rates and missed opportunities in a large, predominantly Hispanic, safety-net primary care population. Methods: We conducted a retrospective cohort study of adults aged ≥ 18 years who received care at University of Texas Rio Grande Valley–affiliated clinics between November 1, 2023, and October 31, 2024. HCV screening completion was defined as an antibody test with laboratory results and, when the antibody test was positive, reflex RNA testing. Missed opportunity was defined as remaining unscreened despite ≥ 2 primary care encounters. Multivariable logistic regression was used to identify independent predictors of screening completion and missed opportunities. Results: Among 7,592 eligible patients, only 568 (7.5%) completed screening. Almost two-thirds (65.5%) had ≥ 2 visits, of whom 90.0% (4,477/4,974) remained unscreened, representing 59.0% of the total cohort. Screening increased with visit frequency but remained low overall (2.7% with 1 visit vs. 12.1% with ≥ 4 visits). In multivariable analysis, Spanish-language preference (aOR 1.78; 95% CI 1.44–2.20) and public insurance (aOR 1.79; 95% CI 1.39–2.31) were strongly associated with screening completion. Each additional visit increased screening odds (aOR 1.16; 95% CI 1.13–1.19), yet screening remained below 13% even among patients with ≥ 4 visits. Conclusions: HCV screening rates were significantly low despite frequent healthcare visits, with many missed opportunities in this safety-net population. System-level factors, rather than patient characteristics alone, appear to drive screening gaps. Automating screening and reducing reliance on visit-based clinician decisions are essential for increasing uptake and advancing HCV elimination efforts. Clinical trial number: Not applicable.
SN - 1471-2334
ER -