Abstract
IntroductionChronic hepatitis C virus (HCV) infection is a significant public health problem. Strategies to identify more HCV infections and improve linkage to care (LTC) are needed. We compared characteristics, treatment and LTC among chronic HCV patients in different health care settings.MethodsNewly diagnosed HCV antibody positive (anti-HCV+) patients within settings of acute care, inpatient and outpatient in one health system were studied. Proportion of LTC and treatment were analyzed only for HCV RNA positive patients. Chi-square, one-way ANOVA and logistic regression were used to compare the characteristics and outcomes in the three care settings. Patients in acute care settings were excluded from multivariate analyses due to low sample size.ResultsAbout 43, 368, and 1159 anti-HCV+ individuals were identified in acute care, inpatient, and outpatient, respectively. Proportion of RNA positivity in acute, inpatient, and outpatient were 47.8, 60.3 and 29.2%, respectively (p < 0.01). After adjusting for age, insurance type, race, and gender, outpatients had higher odds of LTC and of treatment (OR 4.7 [2.9, 7.6] and 4.5 [2.8, 7.3]).ConclusionsInpatients had lower proportion of LTC and treatment compared to outpatients. Use of LTC coordinators and the provision of integrated service for specialty care may improve outcomes.
Highlights
Chronic hepatitis C virus (HCV) infection is a significant public health problem
In two recent studies of HCV screening programs conducted in the emergency room, appointment attendance to specialty care after a positive HCV test was as low as 24%, and only a third of patients were successfully linked to HCV care (Franco et al, 2016; White et al, 2016)
A total of 1,570 patients were identified as anti-HCV+
Summary
Chronic hepatitis C virus (HCV) infection is a significant public health problem. Strategies to identify more HCV infections and improve linkage to care (LTC) are needed. In two recent studies of HCV screening programs conducted in the emergency room, appointment attendance to specialty care after a positive HCV test was as low as 24%, and only a third of patients were successfully linked to HCV care (Franco et al, 2016; White et al, 2016) In another large study examining appointment keeping behaviors in HIV/HCV and HCV infected individuals in a large urban network of primary care clinics, 67% of patients kept at least one follow up appointment (Pundhir et al, 2016). In a study that followed patients in a single infectious disease clinic from referral to SVR, only 53% of the patients achieved SVR (Zuckerman et al, 2018) Addressing these issues seems to be an important prerequisite to reduce HCV morbidity and mortality
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