HCV infection, risk-based screening failed to identify the majority of individuals with HCV infection due to both clinician and patient barriers.(9-12) Analysis of the 2003-2010 National Health and Nutrition Examination Survey prevalence data demonstrated that approximately three fourths of individuals with chronic hepatitis C in the United States belonged to the 1945-1965 birth cohort.(13) Based on these data, both the CDC and the US Preventive Services Task Force (USPSTF) recommended one-time hepatitis C screening of all individuals in this birth cohort (1945-1965) regardless of risk factors.(14, 15) Since these recommendations were established in 2012, HCV epidemiology in the United States has changed. Hepatitis C infection incidence nearly quadrupled from 2010 to 2017, primarily driven by increased injection drug use related to the opioid epidemic.(16-19) CDC viral hepatitis surveillance data indicate progressively increasing acute HCV infection incidence each year from 2009 through 2017. Most of these new HCV infections occurred in persons born after 1965, with those aged 20-39 years accounting for the majority of cases. This ongoing trend has spurred interest in expanding HCV screening among the general US population. Several modeling studies suggest the cost-effectiveness of such an approach.(20-23) Accordingly, the AASLD–IDSA guidance HCV screening and follow-up recommendations have been updated and include recommended universal HCV screening for all adults aged 18 years or older followed by periodic testing for persons with ongoing risk behaviors and/or exposures. oNe-tIMe, UNIVeRSal HepatItIS C SCReeNINg FoR aDUltS