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New Study Highlights Need for Hepatitis C Screening for U.S. Military Applicants

October 21, 2015
Hepatitis C screening would increase military blood safety and decrease costs for DoD

A new study shows that two-level screening of military applicants for hepatitis C (HCV)—via antibody screening and a confirmatory nucleic acid test—could not only reduce enlistment of infected individuals and increase battlefield blood safety, but also save the DoD an estimated $3.1 million annually. The study was published online today in the journal Hepatology.

Battlefield whole blood transfusion—the use of freshly collected blood products—has been an important feature of combat casualty resuscitative care in the conflicts in Iraq and Afghanistan. The U.S. military uses whole blood when stored blood components are not available in theater, or when these components are insufficient for resuscitation.

“Screening will decrease the threat to the battlefield blood supply, may lead to earlier diagnosis and linkage to care for individuals with HCV infection, and these data show that a screening program will lead to cost savings due to treatment costs avoided,” said Dr. Paul Scott, MHRP researcher and senior author on the paper.

With no screening, the cost to the DoD of treating the estimated 93 cases of chronic HCV cases from a single year’s accession cohort was $9.3 million. Screening with HCV antibody test followed by nucleic acid test for confirmation yielded a net annual savings and a $3.1 million dollar advantage over not screening.

In the study, researchers analyzed a random sample of 10,000 Army, Navy, Air Force, and Marine Corps service members (active and reserve components) who ended their most recent deployment to combat operations in Iraq and Afghanistan in the period from 2007 through 2010.

The study shows that most HCV infections present among service members who deploy were present at accession, therefore an accession-screening program should markedly reduce the number of deployed service members with HCV infection who may enter the battlefield blood. Screening for chronic HCV infection by EIA test followed by confirmation with NAT minimizes accessions of HCV infected applicants while reducing inappropriate exclusion of fully qualified applicants.

This collaborative study involved the Armed Services Blood Program Office, MHRP, U.S. Army Public Health Center (Provisional), Navy Bloodborne Infection Management Center and the U.S. Air Force HIV Medical Evaluation Unit, under the direction of the Joint Staff Surgeon.

The paper, titled “An Investigation of the Sero-epidemiology of Viral Hepatitis (Hepatitis B and C) in the Deployed Force,” is available at http://onlinelibrary.wiley.com/doi/10.1002/hep.28303/abstract