Reviewer ’s report  
 
Title: Implement ation of Baby Boomer Hepatitis C Screening and Linking to Care in  
Gastroenterology Practices: A Multi -Center Pilot Study  
 
 
Version: 0 Date: 03 Dec 2015  
 
 
Reviewer: Benjamin Maasoumy  
 
 
Reviewer's report:  
 
The study by Younossi et al concerns an important topic. Althou gh the relevance of the baby -
boomer population has only been confirmed for the US, screening programs are needed in all 
countries with sufficient access to care in order to minimize the HCV related morbidity and 
mortality. The major point of the study is t hat in a general setting the prevalence of HCV even in 
a suspected high prevalence cohort seems to be low in the US. This should be the main point in 
the discussion. Another interesting result is the impact on HRQL, which needs to be described 
and analyzed  more precisely. While the study has a couple of strong points, there are also some 
important limitations. I have some additional specific comments:  
 
Major comments:  
1. Why was the screening for typical HCV risk factors limited to the HCV Ab positive 
popula tion? This is an important limitation. In my opinion, all patients should have been 
asked for previous IVDU and blood transfusion before 1990.  
 
2. The success rate in linkage to care should be reported more carefully. There are only 4 
HCV RNA positive patients in the study. This should be removed from the abstract. Page 
10: I do not think that this can be considered as a significant finding as onl y four patients 
are affected in a clinical trial setting.  
 
3. Was depression different between HCV RNA positive and HCV Ab positive, RNA 
negative patients?  
4. What was the stage of liver disease in the HCV RNA positive patients? Was the 
screening able to de tect early clinically unapparent disease?  
 
5. Page 10, line 31: Several common risk factors for HCV infection were not assessed in 
this study.  
 
6. Page 10, line 30: This is difficult to understand: Risk factors for HCV infection (HCV Ab 
positivity) or risk f actors for chronic HCV (being viremic if HCV Ab positive)?  
 
7. Page 11, line 11: This is already mentioned above and prevalence data already been 
compared. The whole part can be deleted.  
 
8. Reference list is incomplete! It stops at ref 50 but there is a cit ation 59  
 
9. Rodger et al Hepatology 1999 should be cite  
 
Minor comments:  
1. Page 4 line 46: A reference is missing.  
 
2. Recent papers by Razavi, Bruggmann and Wedemeyer should be discussed (J Viral 
Hepatitis 2014)  
 
3. Abbreviations should be used the same wa y through the manuscript: HCV antibody = 
HCV AB and HCV Ab  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently apply ing for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other fina ncial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
Speaking/Consulting: Abbott, Roche, Abbvie, MSD/Merck, BMS, Janssen -Cilaq, Fujirebio 
Europe  Resaearch grants: Roche and Abbott Molecular  Travel grants: Janssen -Cilaq, BMS und 
Gilead  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is ac cepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY licen se (http://creativecommo ns.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Implement ation of Baby Boomer Hepatitis C Screening and Linking to Care in  
Gastroenterology Practices: A Multi -Center Pilot Study  
 
 
Version: 0 Date: 03 Dec 2015  
 
 
Reviewer: Benjamin Maasoumy  
 
 
Reviewer's report:  
 
The study by Younossi et al concerns an important topic. Althou gh the relevance of the baby -
boomer population has only been confirmed for the US, screening programs are needed in all 
countries with sufficient access to care in order to minimize the HCV related morbidity and 
mortality. The major point of the study is t hat in a general setting the prevalence of HCV even in 
a suspected high prevalence cohort seems to be low in the US. This should be the main point in 
the discussion. Another interesting result is the impact on HRQL, which needs to be described 
and analyzed  more precisely. While the study has a couple of strong points, there are also some 
important limitations. I have some additional specific comments:  
 
Major comments:  
1. Why was the screening for typical HCV risk factors limited to the HCV Ab positive 
popula tion? This is an important limitation. In my opinion, all patients should have been 
asked for previous IVDU and blood transfusion before 1990.  
 
2. The success rate in linkage to care should be reported more carefully. There are only 4 
HCV RNA positive patients in the study. This should be removed from the abstract. Page 
10: I do not think that this can be considered as a significant finding as onl y four patients 
are affected in a clinical trial setting.  
 
3. Was depression different between HCV RNA positive and HCV Ab positive, RNA 
negative patients?  
4. What was the stage of liver disease in the HCV RNA positive patients? Was the 
screening able to de tect early clinically unapparent disease?  
 
5. Page 10, line 31: Several common risk factors for HCV infection were not assessed in 
this study.  
 
6. Page 10, line 30: This is difficult to understand: Risk factors for HCV infection (HCV Ab 
positivity) or risk f actors for chronic HCV (being viremic if HCV Ab positive)?  
 
7. Page 11, line 11: This is already mentioned above and prevalence data already been 
compared. The whole part can be deleted.  
 
8. Reference list is incomplete! It stops at ref 50 but there is a cit ation 59  
 
9. Rodger et al Hepatology 1999 should be cite  
 
Minor comments:  
1. Page 4 line 46: A reference is missing.  
 
2. Recent papers by Razavi, Bruggmann and Wedemeyer should be discussed (J Viral 
Hepatitis 2014)  
 
3. Abbreviations should be used the same wa y through the manuscript: HCV antibody = 
HCV AB and HCV Ab  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently apply ing for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other fina ncial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
Speaking/Consulting: Abbott, Roche, Abbvie, MSD/Merck, BMS, Janssen -Cilaq, Fujirebio 
Europe  Resaearch grants: Roche and Abbott Molecular  Travel grants: Janssen -Cilaq, BMS und 
Gilead  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is ac cepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY licen se (http://creativecommo ns.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Implement ation of Baby Boomer Hepatitis C Screening and Linking to Care in  
Gastroenterology Practices: A Multi -Center Pilot Study  
 
 
Version: 0 Date: 03 Dec 2015  
 
 
Reviewer: Benjamin Maasoumy  
 
 
Reviewer's report:  
 
The study by Younossi et al concerns an important topic. Althou gh the relevance of the baby -
boomer population has only been confirmed for the US, screening programs are needed in all 
countries with sufficient access to care in order to minimize the HCV related morbidity and 
mortality. The major point of the study is t hat in a general setting the prevalence of HCV even in 
a suspected high prevalence cohort seems to be low in the US. This should be the main point in 
the discussion. Another interesting result is the impact on HRQL, which needs to be described 
and analyzed  more precisely. While the study has a couple of strong points, there are also some 
important limitations. I have some additional specific comments:  
 
Major comments:  
1. Why was the screening for typical HCV risk factors limited to the HCV Ab positive 
popula tion? This is an important limitation. In my opinion, all patients should have been 
asked for previous IVDU and blood transfusion before 1990.  
 
2. The success rate in linkage to care should be reported more carefully. There are only 4 
HCV RNA positive patients in the study. This should be removed from the abstract. Page 
10: I do not think that this can be considered as a significant finding as onl y four patients 
are affected in a clinical trial setting.  
 
3. Was depression different between HCV RNA positive and HCV Ab positive, RNA 
negative patients?  
4. What was the stage of liver disease in the HCV RNA positive patients? Was the 
screening able to de tect early clinically unapparent disease?  
 
5. Page 10, line 31: Several common risk factors for HCV infection were not assessed in 
this study.  
 
6. Page 10, line 30: This is difficult to understand: Risk factors for HCV infection (HCV Ab 
positivity) or risk f actors for chronic HCV (being viremic if HCV Ab positive)?  
 
7. Page 11, line 11: This is already mentioned above and prevalence data already been 
compared. The whole part can be deleted.  
 
8. Reference list is incomplete! It stops at ref 50 but there is a cit ation 59  
 
9. Rodger et al Hepatology 1999 should be cite  
 
Minor comments:  
1. Page 4 line 46: A reference is missing.  
 
2. Recent papers by Razavi, Bruggmann and Wedemeyer should be discussed (J Viral 
Hepatitis 2014)  
 
3. Abbreviations should be used the same wa y through the manuscript: HCV antibody = 
HCV AB and HCV Ab  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently apply ing for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other fina ncial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
Speaking/Consulting: Abbott, Roche, Abbvie, MSD/Merck, BMS, Janssen -Cilaq, Fujirebio 
Europe  Resaearch grants: Roche and Abbott Molecular  Travel grants: Janssen -Cilaq, BMS und 
Gilead  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is ac cepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY licen se (http://creativecommo ns.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant