Missed opportunities for universal hepatitis C screening in a predominantly hispanic safety-net popaulation: a retrospective cohort study

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. 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. 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. 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. Not applicable.