BACKGROUND: Hepatitis C virus (HCV) is a risk factor for advanced liver disease and mortality
however, efficacious direct-acting antiviral therapy is available for those who are screened for and ultimately diagnosed with HCV, highlighting the importance of population-based screening. For nearly 25 years, the Veterans Health Administration's (VHA) National Viral Hepatitis Program has leveraged resources to improve screening, diagnosis, and access to HCV care. We aim to assess the status of HCV screening in veterans in care 2021-2023 and identify emerging high-prevalence groups to direct future interventions. METHODS: We performed a retrospective cohort analysis evaluating receipt of HCV testing among individuals aged 18-79 years in VHA care 2021-2023. We performed descriptive analyses of demographic and clinical characteristics, as well as the proportions who received HCV screening and confirmatory testing and the proportion with positive test results. RESULTS: In 2021-2023, there were 6 637 294 individuals in VHA care aged 18-79 years. Of these, 75% had received HCV testing, of whom 5% were antibody positive with 95.5% receiving confirmatory testing. Veterans with alcohol use disorder, opioid use disorder, stimulant use disorder, mental health diagnoses, unstable housing, advanced liver disease, hepatitis B, or HIV, all had a statistically significant increased odds of receipt of HCV testing and test positivity. CONCLUSIONS: The VHA has successfully tested three quarters of veterans in care 2021-2023, with >
95% of those with a positive antibody receiving a confirmatory test. The VHA comprehensive approach to HCV testing can serve as a model for other health systems.