Hepatitis C screening strategies and linkage-to-care approaches in U.S. emergency departments: A systematic review and meta-analysis

Objective Hepatitis C virus (HCV) infection remains a public health concern in the U.S. Emergency departments are pivotal for the identification of undiagnosed HCV infections. This study seeks to estimate outcomes across hepatitis C virus antibody screening strategies and linkage-to-care approaches implemented in U.S. emergency departments (EDs). Methods We searched online databases (e.g., Embase, PubMed) for studies published between January 2014 and December 2024 evaluating HCV care cascade outcomes in ED settings. When necessary, we surveyed corresponding authors to clarify patient navigation strategies. We used random-effects models to estimate pooled percentages with 95% confidence intervals. Results The 21 included studies represented 235,725 individuals. Pooled HCV screening was estimated at 45% and higher for Baby Boomer–based targeted screening (54%) and lower for risk-based targeted screening (38%) than for universal screening (51%). Independent pooled estimates of treatment initiation and cure were higher among alternative linkage-to-care approaches (21% vs 10% and 14% vs 6%, respectively) than among those relying on community health workers. Conclusions HCV screening and linkage-to-care outcomes in ED settings remain suboptimal. Alternative linkage-to-care approaches to patient navigators demonstrate improved linkage-to-care and cure rates. Strengthening linkage-to-care programs along with screening initiatives in U.S. EDs may enhance progress toward HCV elimination.