Hepatitis C virus (HCV) is one of the most common causes of chronic liver disease in the United States, it is estimated that between 0.6 % and 1.5 % of the US population, or 4.1 million persons, have chronic HCV infection [[1], [2], [3]].

Based on the availability of safe and highly effective treatment for HCV, and increased incidence related in part to the opioid epidemic, the World Health Organization has made it a goal to reduce new HCV infections by 90 % and to reduce HCV-related mortality by 65 % by 2030 [[4], [5], [6]].

Routine HCV screening is a key component of elimination efforts. The Centers for Disease Control (CDC) and the United States Preventative Services Task Force (USPSTF) updated screening guidelines in 2020 and currently recommend one-time HCV screening for all adults aged 18–79 and pregnant women with each pregnancy [[7], [8], [9]]. Despite new screening recommendations, HCV screening rates remain suboptimal.

Emergency Departments (EDs) have been shown in prior studies to be feasible and high-yield screening venues. Studies examining universal, nontargeted screening in EDs have shown a high prevalence of HCV and identification of disease in populations that would have been missed with targeted or cohort screening protocols [[10], [11], [12], [13], [14], [15], [16]]. In multiple studies, the prevalence of HCV infection in patients in the ED was higher than in the average population [12,[17], [18], [19], [20], [21], [22]]. Universal HCV screening in the ED may be particularly important in safety-net hospital systems given that they serve a population that may have limited access to primary care, where HCV screening traditionally occurs [11].

Grady Health System (GHS), a safety-net health system in Atlanta, GA, has had an active outpatient clinic-based HCV screening program since 2012, and has found a higher than national average anti-HCV prevalence in the baby boomer birth cohort (born between 1945 and 1965) [[23], [24], [25], [26], [27]]. This program expanded to the inpatient setting in 2017 and to the ED in 2019. Additionally, GHS is home to the Grady Liver Clinic (GLC), a primary care-based HCV treatment clinic which serves as a linkage venue for screening programs at GHS and throughout metro Atlanta [25]. Here we report descriptive characteristics of the populations screened for HCV in the GHS ED and outpatient clinic setting. The primary outcome was to compare the number of patients screened and rates of linkage to care between these two sites. Our secondary outcome was to identify characteristics of ED patients with HCV that were associated with improved LTC.