Abstract
(1) Background: Low rates of hepatitis C virus (HCV) diagnosis and sub-optimal linkage to care constitute barriers toward eliminating the infection. In 2012/2013, we showed that HCV screening in primary care detects unknown cases. However, hepatitis C patients may not receive further diagnostics and therapy because they drop out during the referral pathway to secondary care. Thus, we used an existing network of primary care physicians and a practice of gastroenterology to investigate the pathway from screening to therapy. (2) Methods: HCV screening was prospectively included in a routine check-up of primary care physicians who cooperated regularly with a private gastroenterology practice. Anti-HCV-positive patients were referred for further specialized diagnostics and treatment if indicated. (3) Results: Seventeen primary care practices screened 1875 patients. Twelve individuals were anti-HCV-positive (0.6%), six of them reported previous antiviral HCV therapy, and one untreated patient was HCV-RNA-positive (0.05% of the population). None of the 12 anti-HCV-positive cases showed up at the private gastroenterology practice. Further clinical details of the pathway from screening to therapy could not be analyzed. (4) Conclusions: The linkage between primary and secondary care appears to be problematic in the HCV setting even among cooperating partners, but robust conclusions require larger datasets.
Highlights
In 2016, the World Health Organization approved the strategy to eliminate chronic hepatitis C virus (HCV) infection by the year 2030 [1], which was adopted by the GermanMinistry of Health with the BIS2030 initiative [2]
We have initiated a hepatitis C screening program on top of a preventive medical examination covered by German health care insurance in the primary care setting and developed screening strategies based on guideline-defined risk scenarios [6]
In the present study, we focused on linkage-to-care and used an existing network of primary care physicians and a specialized private practice of gastroenterology to investigate an ideal pathway from the screening to referral of newly identified HCV patients with the documentation of further diagnostic steps and initiation of therapy
Summary
In 2016, the World Health Organization approved the strategy to eliminate chronic hepatitis C virus (HCV) infection by the year 2030 [1], which was adopted by the GermanMinistry of Health with the BIS2030 initiative [2]. We have initiated a hepatitis C screening program on top of a preventive medical examination covered by German health care insurance in the primary care setting and developed screening strategies based on guideline-defined risk scenarios [6]. This approach was successful in identifying previously unknown HCV infections and is in line with the recent national data, which report a higher number of annually diagnosed HCV patients during the years 2018 and 2019 compared to 2017 [7]. A follow-up of the index patients from the study by Wolffram et al indicated that further
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