Implementation of Baby Boomer Hepatitis C (HCV) Screening and Linking to Care in Gastroenterology (GE) Practices: A Multicenter Pilot Study

Abstract

Introduction: Treatment of HCV has been limited by identification of infected patients and by linking them to care. Some estimates suggest that only 20% of HCV-infected patients have been identified and < 10% have been treated. In addition, baby boomers born between 1945 and 1965 have been identified as having higher prevalence of HCV leading to screening recommendations by the Centers for Disease Control and Prevention (CDC). The aim of this study was to implement the CDC's screening recommendations in GE practices. Methods: This was a multi-center study involving 5 GE practices selected by the American College of Gastroenterology and the Chronic Liver Disease Foundation (CLDF). After obtaining patient informed consent, demographics, clinical and quality of life (QoL) data were collected. A blood sample was screened for HCV antibody (HCV AB) using the OraQuick HCV Rapid Antibody Test. HCV ABpositive patients were tested for presence of HCV RNA and, if HCV RNA-positive, linked to a clinician for treatment discussons. Results: We screened 2,000 subjects in 5 GE centers located close to large metropolitan areas on the East Coast (3 Northeast, 1 Mid-Atlantic and 1 Southeast). Of the screened subjects, 39.8% were male, age 59.7±6.0 years, 72% White, 5% Black, and 20% Hispanic. Thirty percent self-reported a history of anxiety, 22% of depression, and 38% of clinically overt fatigue. Additionally, 15.6% had a history of diabetes, 43.4% of hypertension, 47.8% of hyperlipidemia, 27.5% reported drinking alcohol and 10.2% smoked. Of the screened population, 10 patients (0.5%) were HCV AB-positive. HCV RNA testing was performed in 90% (9/10) of HCV AB-positive patients. Of those, 44.4% (4/9) were HCV RNA-positive, and all 4 (100%) were linked to a HCV treater. Compared to HCV AB-negative subjects, in HCV AB-positive patients, there was a trend towards a higher proportion of Blacks (20.0% vs. 5.2%, p=0.09). Also, HCV AB-positive patients more frequently reported a history of depression: 60.0% vs. 21.5%, p=0.009. HCV AB-positive patients also had lower QoL as documented by more fatigue, poor concentration, and more frequently reported decreased level of energy (p < 0.05). Conclusion: Although the prevalence of HCV AB-positive was low in subjects screened in these GE centers (0.5%), linkage to care was high (90% to 100%). HCV AB-positive patients reported more QoL impairment as compared to HCV AB-negative subjects. A history of depression was the only predictor of being HCV AB-positive.