Targeted hepatitis C virus (HCV) testing in the Washington State prison system missed a substantial proportion of HCV cases, and routine testing at entry should be considered, a recent study found. The retrospective analysis was performed using individuals entering the Washington State prison system between 2012 and 2016, which routinely offers HCV testing, to compare routine opt-out with current recommendations for risk-based and 1-time testing for those born between 1945 and 1965. Liver fibrosis stage was also characterized. Researchers found:

• Between 2012, and 2016, 24,567 (83%) individuals were tested for the HCV antibody and 4,921 (20%) were reactive.
• 2,403 (49%) individuals had HCV RNA testing, with 1,727 (72%) showing chronic infection.
• Reactive antibody was more prevalent in those born between 1945 and 1965 compared with other years.
• Up to 35% of positive reactive tests would be missed with testing targeted by birth cohort and risk behavior.
• 23% of chronically infected individuals had at least 1 moderate liver fibrosis.