Improving Cascade of Hepatitis C Care Through Linkage to C Care Program (LTC)

Abstract

Introduction: The epidemic of injectable drug use accounts for at least 75% of new HCV infections in the United States; most of whom fail to seek treatment for this curable illness. The Center for Disease Control (CDC) recommends targeted HCV testing in the people who inject drugs (PWID) population. Therefore, increasing education, screening, and linkage to care by working through environments which cater to this audience such as methadone clinics, Sober Living Homes, and drug rehabilitation centers. One challenge in testing PWID is the inability of these individuals to follow through with linkage to careand treatment following a positive test. Our aim is to screen the PWID population and link individuals that are HCV RNA positive to care, and utilize our online patient database management system (PDMS) with our Substance Abuse Treatment Center partners to fulfill the linkage portion. Methods: Longitudinal prospective cohort study with HCV screening at the above centers and utilization of a HIPPA compliant online patient database management system (PDMS) (http://www.linkagetocare.com). A centrally located Linkage to Care Specialist (LTCS) is notified immediately when an individual is entered in the system by the treatment center or is self-referred. The LTCS educates the individual and proceeds to link that person to care. Results: January 2017 - May 2017, 289 HCV RNA positive patients referred (31% self-referred and 54% referred from 24 facilities in 15 states); 66% patients were uninsured; Median age of patients 41 (19-77); 58% males. 246 (85%) patients were contacted by LTCS; 173 (70%) HCV patients referred by the LTCS to a medical provider; patients were contacted within 2 days after referral. On average, patients were contacted twice before scheduling their first appointment. 120 (49%) patients made it to their first appointment and 30 (25%) of them initiated HCV treatment; 9 (30%) patients finished therapy. 70% of patients were from sober living; 71% seen in office vs. 14% through telemedicine. Conclusion: Targeting PWID is an effective way of reducing the prevalence of HCV infection and ultimately eliminating HCV in high risk communities. The LTC model results in an increase in patient compliance as compared to the failed cycle of current care models. The continued goal of this project will be to enhance HCV identification amongst at-risk populations, further education; providing a link to care for all patients affected by HCV.