Care cascade of patients with hepatitis C and HIV identified by emergency department screening

Abstract

We compared the care cascades of Hepatitis C (HCV) mono-infected and HCV/HIV co-infected patients screened in a universal Emergency Department (ED) HCV screening program. This was a retrospective review of program data collected between June 6, 2018 and December 31, 2019. HIV and HCV status, linkage to care and treatment outcomes were abstracted from the program-screening database. Descriptive statistics were used to characterize the population. Group comparisons (HCV mono-infected vs. HIV/HCV co-infected) were compared using Chi-square. There were 116,596 adult (age 18 y and above) patient visits, representing 62,001 unique individuals. Of these, 17,676 (28.5%) received an HCV antibody test. We identified 418 evaluable patients (2.4%) with active HCV (HCV RNA positive). Of these, 337 (81%) were HCV mono-infected, 58 (14%) were HCV/HIV co-infected and 23 (5%) had unknown HIV status. Among the 418 evaluable patients 174 (41%) were linked to care and 94 (22.5%) achieved sustained virologic response (SVR).There were no significant differences between HCV mono-infected and HCV/HIV co-infected groups at any step of the care cascade (diagnosed and aware, linked to care, medications prescribed or SVR). Universal HCV screening in the ED identified a large number of patients with active HCV infection, of which 14% were co-infected with HIV. While there were no differences in the care cascades between mono and co-infected patients, linkage and treatment outcomes were low in both groups. Barriers to linkage to care and treatment after ED diagnosis should be further investigated and addressed to improve public health outcomes.