1250. Screening for Hepatitis C as Part of an Opioid Stewardship Initiative: Identifying Infected Patients and Analyzing Linkage to Care

Abstract

Abstract Background Hepatitis C (HCV) remains a major cause of liver-related morbidity and mortality even though direct-acting antiviral drugs (DAAs) are increasingly accessible and have cure rates approaching 100%. The demographics of HCV have shifted to younger patients, primarily due to the opioid epidemic and associated increased numbers of people who inject drugs (PWID). A robust screening program targeting patients with opioid use disorder (OUD) can identify patients with HCV and present opportunities for linkage to care, cure, and disease prevention by breaking the chain of transmission in high-risk groups. Methods As part of an organizational opioid stewardship long-term goal (2018-2020), Novant Health screened patients with OUD for HCV. A best practice alert (BPA) in the electronic health record (EHR) prompted providers to order HCV antibody. Management of positive tests was left to the discretion of the ordering provider. The disposition of patients with a positive HCV antibody was evaluated by retrospective chart review with patients categorized as: (a) known spontaneous virus clearance (b) linked to care with HCV specialist (c) previous treatment (d) not appropriately linked to care (e) not linked to care due to patient-directed discharge or nonadherence. Results Of 5560 patients encountered (average age 40.9, 49% female, 73.7% White, 21.8% AA/Black), 4405 patients were tested. Of those screened, 33.9% were positive. Among those with a positive HCV antibody, 24% had known spontaneous viral clearance and 73.9% needed linkage to care or follow up bloodwork, with 301 linked to care and 804 not successfully linked. Of eligible patients, 27.2% were linked to care. Conclusion There is a need for ongoing screening efforts in patients with OUD. Despite a BPA intervention, a large percentage of positive patients were not appropriately linked to care. Barriers to linkage include lack of provider education on HCV referral and treatment concurrent to the BPA rollout, as well as psychiatric comorbidities and social vulnerabilities more prevalent in patients with OUD. Disclosures All Authors: No reported disclosures.