HCV Screening Rates Research Articles

Screening rates for hepatitis B and C among low-income US veterans: Data from the National Veteran Homeless and Other Poverty Experiences Study.

Screening for viral hepatitis is considered a high-priority area in the Veterans Health Administration (VHA). Yet, few studies have examined viral hepatitis screening test use among low-income veterans who are considered high-risk with limited healthcare access. Using cross-sectional data from 933 participants in the 2021-2022 National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study, we examined rates and correlates of lifetime screening for hepatitis B (HBV) and hepatitis C (HCV) infections. Multivariable logistic regression models evaluated characteristics associated with HBV/HCV screening. Nearly 16% and 21% reported lifetime HBV and HCV screening, respectively. These rates are considerably lower than HBV (47.3%) and HCV (92.9%) screening rates documented among contemporaneous veterans in VHA electronic health records. In the NV-HOPE data, veterans 50-79 years were more likely than those ≥80 years of age to ever-screen for HBV/HCV. Whereas, household income was inversely related to lifetime screening behaviours, veterans reporting 'other' employment types (vs. full-time/part-time employment) were more likely to ever-screen for HBV/HCV. Ever-screening for HBV was more likely among veterans reporting non-Hispanic 'other' (vs. non-Hispanic 'white') race, housing instability, Medicaid insurance, as well as drug use and cognitive disorder histories. Living with ≥5 members (vs. alone), histories of alcohol use, cancer, and liver disorders were also correlated with ever-screening for HCV. HIV/AIDS history correlated with ever-screening for HBV/HCV. In conclusion, fewer than one-third of low-income US veterans ever-screened for HBV/HCV, with lower screening rates among those less likely to be exposed to viral hepatitis, thereby informing interventions aimed at promoting available screening, treatment and vaccinations for HBV/HCV.

THU-173 - HCV screening rates in reproductive age women after universal screening guidelines

THU-173 - HCV screening rates in reproductive age women after universal screening guidelines

HCV universal EHR prompt successfully increases screening, highlights potential disparities.

Screening for hepatitis C virus is the first critical decision point for preventing morbidity and mortality from HCV cirrhosis and hepatocellular carcinoma and will ultimately contribute to global elimination of a curable disease. This study aims to portray the changes over time in HCV screening rates and the screened population characteristics following the 2020 implementation of an electronic health record (EHR) alert for universal screening in the outpatient setting in a large healthcare system in the US mid-Atlantic region. Data was abstracted from the EHR on all outpatients from 1/1/2017 through 10/31/2021, including individual demographics and their HCV antibody (Ab) screening dates. For a limited period centered on the implementation of the HCV alert, mixed effects multivariable regression analyses were performed to compare the timeline and characteristics of those screened and un-screened. The final models included socio-demographic covariates of interest, time period (pre/post) and an interaction term between time period and sex. We also examined a model with time as a monthly variable to look at the potential impact of COVID-19 on screening for HCV. Absolute number of screens and screening rate increased by 103% and 62%, respectively, after adopting the universal EHR alert. Patients with Medicaid were more likely to be screened than private insurance (ORadj 1.10, 95% CI: 1.05, 1.15), while those with Medicare were less likely (ORadj 0.62, 95% CI: 0.62, 0.65); and Black (ORadj 1.59, 95% CI: 1.53, 1.64) race more than White. Implementation of universal EHR alerts could prove to be a critical next step in HCV elimination. Those with Medicare and Medicaid insurance were not screened proportionately to the national prevalence of HCV in these populations. Our findings support increased screening and re-testing efforts for those at high risk of HCV.

Improving Hepatitis C Screening in Inpatient Psychiatry.

Improving Hepatitis C Screening in Inpatient Psychiatry.

Pharmacist-led drug therapy management for hepatitis C at a federally qualified health care center

BackgroundChronic hepatitis C (HCV) infection is challenging to address in patients with barriers to accessing care, including those from underserved populations. Linking at-risk patients through the HCV cascade of care can address such disparities by leveraging existing patient–provider relationships to identify and treat HCV. Pharmacists are ideal clinical team members to provide direct-acting antiviral (DAA) management, given their expertise in pharmacotherapy and medication access. However, literature describing pharmacist-led DAA management at federally qualified health centers (FQHCs) is limited. Objective(s)To describe HCV screening, DAA prescribing and treatment initiation, post-treatment sustained virologic response (SVR) assessment, and treatment outcomes in an FQHC with pharmacist-led DAA management. MethodsThis study describes HCV screening rates in adults with select HCV risk factors receiving primary care at a Midwest FQHC over a 4-year period. In patients with a detectible HCV viral load, DAA prescription orders for patients referred to pharmacist-led DAA management was evaluated in comparison with usual care. Treatment completion and SVR results were assessed in patients referred to pharmacists. ResultsHCV screening in patients with identifiable risk factors increased from 8.0% to 67.5% over 4 years, driven by a clinical reminder for HCV screening in the birth year cohort. Of patients with positive HCV viral load results, 9.9% in the usual care group received an order for DAA therapy versus 57.1% (P < 0.001) in the pharmacist-led DAA management group. Of 162 patients referred to pharmacist-led DAA management, 61 (37.7%) initiated therapy. Of patients who initiated treatment, 57 (94.7%) had post-treatment viral load testing, with 46 (80.7% of treated patients) having SVR results and 45 (97.8% of SVR tested patients) testing negative. No usual care patients had subsequent negative HCV viral load results. ConclusionPharmacist-led DAA management is an effective intervention to improve the treatment of patients with HCV in the FQHC setting.

904. Improving Infectious Disease Screening and Hepatitis C Care Cascade Outcomes Among Adults Receiving Medication Assisted Treatment

Abstract Background This initiative increased infectious disease (ID) screening in an adult medication assisted treatment (MAT) population at a Federally Qualified Health Center (FQHC) by implementing opt-out screening for HIV, viral hepatitis, and sexually transmitted infections (STIs), and assessed the success of a co-located hepatitis C (HCV) treatment program. Methods ID providers maintained a standing lab order for HIV, hepatitis A, hepatitis B, HCV, syphilis, chlamydia/gonorrhea (GC/CT), and trichomoniasis (trich), with reflex to confirmatory for HIV/HCV/syphilis. For all existing and new adult MAT patients, a MAT RN provided education, ensured lab draw on the day of MAT induction, and scheduled an ID follow-up visit. The patient then had an in-person or telemedicine visit with the ID provider to review results, discuss risk reduction, and initiate treatment (HIV PrEP or treatment for STI, HCV, or HIV) as indicated. Data was compiled and monitored by a Prevention RN. Plan, Do, Study, Act (PDSA) Model PDSA model demonstrating implementation approach Results The rate of testing among MAT patients increased over a one-year period. HCV treatment uptake in this setting exceeded that documented in published data for people who inject drugs (PWID). HCV Care Cascade Outcomes HCV screening and treatment outcomes within HCV Care Cascade model Screening Outcomes Screening rates among adult MAT population over a one-year measurement period Conclusion This study documents the successful implementation of an opt-out screening program among an adult substance use disorder (SUD) treatment population across urban, mixed, and designated rural environments. HCV treatment uptake in this setting exceeded that documented in published data for people who inject drugs (PWID). Barriers to implementation included acceptance among patients with long-term MAT participation, acceptance/adoption by behavioral health nursing and provider staff, and functional workflow development – establishment of protocol, lab availability, scheduling, and “tough sticks.” Modifications that increased effectiveness included an interdisciplinary approach and dedicated staff for monitoring results completion and patient outreach. Run chart: HIV screening rates over a one-year period HIV screening change among adult MAT patients over a one-year period Run chart: HCV screening rates over a one-year period HCV screening change among adult MAT patients over a one-year period HCV Care Cascade: HCV screening and treatment outcomes HCV screening and treatment outcomes presented in HCV Care Cascade for adult MAT population Disclosures All Authors: No reported disclosures

918. 2019 Implementation of Universal Hepatitis C Screening at an Urban Federally Qualified Health Center: A Descriptive Analysis and Lessons Learned

BackgroundHepatitis C infection (HCV) is a curable disease that can be effectively managed by non-specialists. Delaware has high HCV rates but limited resources to care for individuals with HCV. Successful HCV micro-elimination starts with universal HCV screening and case identification. MethodsChristianaCare (CC) and Westside Family Healthcare (WFH), Delaware’s largest federally qualified health center (FQHC), created a multidisciplinary initiative to support comprehensive HCV care from July 2018-2020 (Figure 1). As part of this partnership, universal opt-out HCV screening in eligible (no prior HCV RNA result) adults ≥ 18 years was implemented at a pilot site in Wilmington in 2019. To characterize screening practices, pre- (risk-based screening) and post-intervention (universal screening) electronic health record data was collected following the first 6 months of the intervention (Jan-June 2019). An HCV dashboard was created and updated monthly to evaluate trends in 2019 screening rates. Collaboration was supported through a 2-year CC Harrington grant. Figure 1. Components of Federally Qualified Health Center HCV Medical Care Model Table 1. Pilot Site Patient Characteristics ResultsPre- and post-intervention patient characteristics and screening data are presented in Table 1 and Figure 2 respectively. 39% of patients had screening ordered during the first 6 months of universal screening, a 4% increase from baseline. HCV seroprevalence [amongst resulted tests] remained unchanged from baseline at 5%. During the universal screening period, 2.5% (12/482) of individuals with resulted tests had HCV compared to 4.0% (29/795) tested during risk-based screening. HCV dashboard data demonstrated a trend of increased ordering and fulfillment of screening tests (Figure 3). Figure 3. 2019 HCV Dashboard ConclusionThe early adoption of universal HCV screening in adults (prior to 2020 USPSTF update) at an urban FQHC, together with an initiative to provide multidisciplinary HCV care at this FQHC (Figure 1), led to increasing rates of ordered screening. The presented 6-month data does not fully account for lag times between test ordering and fulfillment, resulting in under-reporting of universal HCV screening rates. Multidisciplinary care models to address HCV in patients’ medical homes are vital to HCV eradication with the robust implementation of universal HCV screening a vital first step in this continuum. Disclosures Deborah A. Kahal, MD,MPH, FACP, Gilead (Speaker’s Bureau)Viiv (Speaker’s Bureau)

Universal HCV Screening of Baby Boomers is Feasible, but It is Difficult

Our objective was to assess the impact of mass mailing and the inclusion of Best Practice Advisory (BPA) "Pop-Up" tool in the electronic medical record (EMR) on HCV screening rates. Between June 2015 and March 2020, two interventions were developed for primary care physicians (PCP). An educational letter along with a blood requisition form, signed on behalf of the PCPs, was sent to patients. We also developed a BPA "Pop-Up" screening tool to alert PCPs to order HCV screening tests on patients with no previous screening. Data were collected and analyzed prospectively. When we started the screening program in June 2015, 33,736 baby boomers were eligible for screening, and the hospital system added an additional 26,027 baby boomers between June 2015 and March 2020. Of the 89 primary care providers employed by the hospital, 75 agreed to participate at different time periods. We screened 23,291 (43.5%) of 53,526 eligible patients during study period. Of these, 399 (1.7%) had HCV antibody, but HCV RNA was positive in only 195 (1%). HCV antibody positivity rates were higher in men, blacks, and in 1951-1960 birth cohorts. Spontaneous clearance rates appeared to be lower in men (OR 0.59, 95% CI 0.39-0.90, P= 0.015) and in blacks (OR 0.31, 95% CI 0.20-0.50, P < 0.001). Although a formal screening program increased screening rates for HCV among baby boomers, about 50% of baby boomers remained unscreened. In this community screening program, we found that men and blacks are less likely to have spontaneous HCV clearance.

The impact of electronic medical record system implementation on HCV screening and continuum of care: a systematic review

Introduction and objectivesHepatitis C (HCV) screening is imperative to meet WHO elimination targets including increased detection and reduced mortality. An electronic medical record (EMR) system can be utilized in health care centers to indicate if a patient should be targeted for HCV screening, thus increasing the number of those offered testing. Materials and methodsWe examined English language publications reporting on the impact of EMR system utilization on HCV screening and the HCV continuum of care. Relevant papers were identified using multiple search engines to search key terms. Clinical outcomes considered included any or no change in HCV screening rates following EMR system introduction, as well as any or no change in rates of patients progressing along the HCV cascade of care after diagnosis once an EMR system was implemented. ResultsFrom a search pool of 18 studies, 11 meet inclusion criteria and reported on the selected clinical outcomes. Each outcome assessed indicated that use of an EMR system increased the proportion of patients offered and/or receiving HCV testing. We were unable to conclude if an EMR system had an impact on the number of patients progressing along the HCV cascade of care following a positive test result. Overall, all methods of implementation of an EMR system had the same outcome of increasing screening rates. ConclusionsEMR system utilization had a positive impact on increasing HCV screening. However, the clinical effectiveness of utilizing an EMR system to help eliminate transmission and increase HCV treatment cure rates requires further study.

1059. Evaluating Hepatitis C Screening Rates and Successful Interventions at an Outpatient Medicine/Pediatrics Practice

BackgroundDespite the 2013 United States Preventive Services Task Force (USPSTF) recommendations, Hepatitis C (HCV) screening rates among patients born between 1945-1965 has remained below 25% (MacLean, 2018). At our outpatient academic suburban primary care practice in Albany County, NY, our hepatitis C baseline prior to interventions was 31.75%. In collaboration with Project FOCUS through Gilead, our practice attempted to increase screening rates among this birth cohort.MethodsWe performed a retrospective chart review on patients eligible for HCV screening with birth years 1945-1965 at the time of their visit at the Albany Med Internal Medicine/Pediatrics practice. We report monthly HCV screening from January 2018 to April 2020. In addition, we determined whether HCV screening rates differed by race, gender, ethnicity, private vs public insurance, and risk stratification or RAF (standard vs. high-risk patient).ResultsThe chance that a test conducted for eligible patients increased from 29.9% (pre-intervention) to 58.76% in 2019 (post-intervention). From June 2019- December 2019, the testing rates were consistently above the 2019 average (Figure 1). There were no significant differences in HCV screening due to gender, race, ethnicity, or type of insurance (Table 1).Figure 1. Hepatitis C Screening Rates at an Outpatient Medicine/Pediatrics Practice 2018-2020 Table 1. Demographics - Hepatitis C Screening Rates ConclusionIn this outpatient Med/Peds practice, hepatitis C screening rates increased dramatically after incorporation of an EMR prompt, as well as nursing-generated orders for patients due for screening. There was no statistical difference in screening based on race, ethnicity, gender, or insurance type. Of note, high-risk patients were more likely to be screened, perhaps as they receive more case management services and are more likely to be in the office, increasing the opportunities for screening. The next step would be to adapt these interventions to screening all patients age 18-79, as per the updated 2020 USPSTF guidelines.Disclosures Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Abigale Eichelman, MA, Gilead FOCUS Foundation (Other Financial or Material Support, Employee of Albany Medical Center with Salary Support on Grant) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)

317. Utility of a Hepatitis C Screening Best Practice Advisory in University-based Primary Care Practices

BackgroundHepatitis C virus infection (HCV) is a significant health concern in the United States, impacting an estimated 3 million people. Adults born between 1945 and 1965 (“baby boomers”) are 5 times more likely to have HCV infection compared with the general population. In 2012, the CDC recommended screening of adults born between 1945 and 1965. In April 2018 UConn Health transitioned from utilizing the Next Gen EHR system to Epic. At Epic launch, an HCV-screening Best Practice Advisory (BPA) was implemented, along with 13 other outpatient-based BPAs. This allowed for comparison of HCV screening rates before and after Epic launch.MethodsData were collected via retrospective chart review on adults born between 1945–1965 presenting to UConn primary care (PC) clinics one year prior to and 9 months post Epic launch. The BPA was set to fire for patients in the birth cohort who did not have an HCV antibody result or a history of hepatitis C in the medical record. Proportions were compared using chi-squared tests and Fisher’s Exact test.ResultsThe HCV screening rate among PC providers 1-year pre-BPA was approximately 7.7%. Analysis of data nine months after BPA implementation demonstrated HCV screening rates were unchanged at 7.6%. Table 1 describes initial care cascade findings. During the post-launch monitoring period, a 0.2% [270/105,431] response rate was noted (as measured by follow-up actions taken from all BPAs, Table 2). During the same period, a significantly higher response rate to the HCV-screening BPA was noted (1.2% [287/24,532], P < 0.01) (Figure 1).ConclusionThe aim of this study was to improve HCV case identification and to understand the utility of a BPA in this setting. Within the first nine months, the use of an HCV-screening BPA (Figure 2) in PC clinics did not increase screening rates in adults born between 1945 -1965. Alert fatigue may contribute to low screening rates post BPA, as evidenced by the low response rates across all BPAs introduced. Our long-term goal is to gather additional data to assess the efficacy of the HCV BPA and its effects on the HCV care cascade. Modifications to BPA functionality may be indicated. Disclosures All authors: No reported disclosures.

Hepatitis C Screening in Commercially Insured U.S. Birth-cohort Patients: Factors Associated with Testing and Effect of an EMR-based Screening Alert.

Background and ObjectivesHepatitis C virus (HCV) testing rates among U.S. birth-cohort patients have been studied extensively, limited data exists to differentiate birth-cohort screening from risk- or liver disease-based testing. This study aims to identify factors associated with HCV antibody (HCV-Ab) testing in a group of insured birth cohort patients, to determine true birth cohort testing rates, and to determine whether an electronic medical record (EMR)-driven Best Practice Alert (BPA) would improve birth cohort testing rates.MethodsAll birth-cohort outpatients between 2010 and 2015 were identified. HCV-Ab test results, clinical, and demographic variables were extracted from the EMR, and factors associated with testing were analyzed by logistic regression. True birth-cohort HCV screening rates were determined by detailed chart review for all outpatient visits during one calendar month. An automated Best Practice Alert was used to identify unscreened patients at the point of care, and to prompt HCV testing. Screening rates before and after system-wide implementation of the BPA were compared.ResultsThe historic HCV-Ab testing rate was 11.2% (11,976/106,753). Younger age, female gender, and African American, Asian, or Hispanic ethnicity, and medical comorbidities such as chronic hemodialysis, HIV infection, and rheumatologic and psychiatric comorbidities were associated with higher testing rates. However, during the one-month sampling period, true age cohort-based testing was performed in only 69/10,089 patients (0.68%). Following the system-wide implementation of the HCV BPA, testing rates increased from 0.68% to 10.76% (P<0.0001).ConclusionsWe documented low HCV-Ab testing rates in our baby boomers population. HCV testing was typically performed in the presence of known risk factors or established liver disease. The implementation of an EMR-based HCV BPA resulted in a marked increase in testing rates. Our study highlights current HCV screening gaps, and the utility of the EMR to improve screening rates and population health.

Tu1537 - Birth Cohort HCV Screening Rates Remain Low in Both Primary Care and Subspecialty Clinics

Tu1537 - Birth Cohort HCV Screening Rates Remain Low in Both Primary Care and Subspecialty Clinics

A systematic model improves hepatitis C virus birth cohort screening in hospital-based primary care.

Despite national and local governing board recommendations in the United States of America to perform an HCV screening test in baby boomers, screening rates remain low. Our goal was to study the impact of an HCV screening and link-to-care programme with patient navigation in two New York City primary care practices. This was a 2-year prospective study of patients born between 1945-1965 ("baby boomers") with encounters at two primary care practices at the Mount Sinai Hospital between November 1, 2013 and November 30, 2015. Baseline HCV screening rates were collected for four months. A multifaceted intervention was sequentially implemented involving electronic alerts, housestaff education, data feedback and patient navigation. HCV screening rates and link to care, defined as attending an appointment with a viral hepatitis specialist, were compared before and after these interventions. There were 14642 primary care baby boomer patients of which 4419 (30.2%) were newly screened during the study. There was a significant increase in HCV screening rates from 55% to 75% (P<.01) with an HCV seropositive rate of 3.3%. Factors associated with being HCV seropositive included older age (P<.01), male sex (P<.01), African American race (P<.01) and receiving care in the housestaff practice (P<.01). With patient navigation, 78 of 84 (93%) newly diagnosed HCV-infected persons were referred to a specialist and 60 (77%) attended their first appointment. A structured, multifaceted HCV screening programme using well-studied principles identifies a large number of undiagnosed baby boomers within hospital-based primary care and improves access to specialty providers in a timely manner.

Impact of a Statewide Public Health Mandate and Electronic Medical Record (EMR) Modification on Birth Cohort Hepatitis C Screening: A Single Center Experience

Introduction: Hepatitis C (HCV) screening has become an increasingly important public health initiative with the advent of highly effective antiviral therapies. In 2012, the CDC recommended that the baby boomer generation- all adults born during 1945-1965- undergo a one-time testing for HCV. Despite this recommendation, screening rates have remained inadequate. In response to these shortcomings, on January 1, 2014, the New York State (NYS) Department of Health mandated that all hospital systems and healthcare providers in New York offer HCV screening to the 1945-1965 birth cohort. Several hospital systems have demonstrated high HCV screening rates with the adoption of electronic medical record (EMR) modifications. We sought to evaluate the implementation of an opt-in EMR strategy in the era of NYS's public health mandate on inpatient hepatitis C screening at a tertiary care medical center. Methods: In March 2014, we implemented an institutional opt-in EMR modification that identified patients born in 1945-1965 and prompted medical staff to offer HCV testing at the time of inpatient hospital admission. We retrospectively extracted information from our EMR database to determine the number of HCV tests ordered from January 1, 2013 to December 31, 2015, a timeframe spanning 1 year before the NYS mandate and implementation of our opt-in EMR modification and 2 years after their institution. Results: In 2013, 374 patients (180 birth cohort, 194 other) were screened for chronic hepatitis C. In 2014 and 2015, 1099 patients (800 birth cohort, 299 other) and 1179 patients (788 birth cohort, 391 other) were screened, respectively. There was a 15% screening acceptance rate according to a 9-month survey period in 2014. During a 12-month period from 2014-2015, 4.9% of the baby boomers who were screened were seropositive. 3.4% of non-baby boomers who were screened were seropositive. Conclusion: Our findings demonstrate a sustained, four-fold increase in birth cohort hepatitis C screening after a statewide public health mandate and the implementation of an opt-in EMR modification in an inpatient setting. Additional strategies, including the adoption of an opt-out EMR modification, need to be evaluated and adopted for continued growth in baby boomer hepatitis C screening.

S05 - Management of hepatitis C positive patients undergoing active treatment for malignancies: a position paper from the Associazione Italiana di Oncologia Medica (AIOM) and the Società Italiana di Malattie Infettive e Tropicali (SIMIT)

Background: The association of HBV reactivation and anti-cancer drugs is well-known. However, since HCV reactivation is unusual, little information is available in this setting. Aim of our study was to develop, on behalf of AIOM and SIMIT, practical recommendations for the management of HCV+ pts undergoing antitumor treatment. Methods: Data present in the literature were reviewed, including recommendations and expert opinions on HCV+ pts undergoing antitumor therapy. Experts of the Societies provided additional information for clarifying some issues in the absence of clear-cut information from the literature. Results: HCV screening rates are low in cancer pts. The risk of hepatitis C reactivation is higher with immunosuppressive agents. It may be difficult to separate naturally occurring cancer/therapy-related complications from true reactivation of hepatitis. No conclusive data are available concerning the appropriate monitoring of liver function and when an antiviral regimen has to be given. Conclusions: At present, the following recommendations can be reasonably proposed for the management of HCV+ pts undergoing anticancer therapy:•risk-based and birth cohort-based HCV screening, followed by HCV-RNA tests in positive subjects, has to be performed before initiating active cancer treatment;•monitoring of ALT every 3-4 weeks is necessary. If ALT level raises 3 times the normal value, HCV-RNA should be closely monitored for 3 months following treatment discontinuation;•the risk of hepatitis C reactivation is higher in pts receiving immunosuppressive drugs including rituximab, alemtuzumab, steroids and certain chemotherapeutic agents;•in pts at high risk of reactivation of hepatitis C, treatment with antiviral agents is recommended, especially when anticancer therapy is administered with a curative intent;•when reactivation is diagnosed, the decision to proceed with active anticancer therapy and/or initiating antiviral agents should be based on a discussion of prognosis and therapy options for both conditions. As targeted therapies, including checkpoint inhibitors, are an emerging area of oncology, clinicians treating HCV+ infected pts should be mindful of the potential, in the absence of clear cut data, for their immunosuppressive properties;•collaboration with a hepatologist or an infectious disease specialist is necessary in the management of HCV+ cancer pts. Studies are needed to identify optimal strategies for diagnosis and treatment of this pts.

Improving HCV Screening Rates in an Urban Primary Care Clinic: High Yield Strategies

Improving HCV Screening Rates in an Urban Primary Care Clinic: High Yield Strategies

Self-Reported HIV and HCV Screening Rates and Serostatus Among Substance Abuse Treatment Patients.

Substance users are at increased risk for HIV and HCV infection. Still, many substance use treatment programs (SUTP) fail to offer HIV/HCV testing. The present secondary analysis of screening data from a multi-site randomized trial of rapid HIV testing examines self-reported HIV/HCV testing patterns and serostatus of 2473 SUTP patients in 12 community-based sites that had not previously offered on-site testing. Results indicate that most respondents screened for the randomized trial tested more than a year prior to intake for HIV (52 %) and HCV (38 %). Prevalence rates were 3.6 and 30 % for HIV and HCV, respectively. The majority of participants that were HIV (52.2 %) and HCV-positive (40.5 %) reported having been diagnosed within the last 1-5 years. Multivariable logistic regression showed that members of high-risk groups were more likely to have tested. Bundled HIV/HCV testing and linkage to care issues are recommended for expanding testing in community-based SUTP settings.

Identifying and Fixing Roadblocks to Hepatitis C Screening in the Primary Care Setting

Introduction: Hepatitis C (HCV) infection is estimated to affect >5 million people in the United States, but >60% are unaware of their infection. With more effective curative therapies expected in the next year, identifying patients with HCV will be of significant importance. In 2012, the CDC, with support from the USPSTF, released guidelines recommending one-time screening for HCV in all people born between 1945 and 1965 (age-cohort screening). We sought to quantify the screening rate in a resident-run university-based primary care setting after release of these guidelines and identify barriers to screening. Methods: A retrospective chart review was performed of all patients born from 1945-1965 seen at a tertiary care teaching clinic during a 3-month period. Patients who had a known diagnosis of HCV or had previously been screened were excluded from further analysis, and remaining patients were assessed for screening rates as well as risk factors for HCV infection. After completion of the chart review, an online questionnaire was sent to the resident providers to assess self-reported HCV screening rates as well as reasons for not performing screening. Results: Three hundred ninety-five eligible visits comprising 314 unique patients occurred during the 3-month study period. Of those, 115 (37%) had been previously screened for HCV. Of the remaining 199 patients, only 6 (3%) were screened during the study period. Of these 6 patients, 4 were actually tested for HCV for other reasons (2 IV drug users, 2 with elevated LFT’s). Forty-five resident physicians responded to the questionnaire regarding their HCV screening practices. The self-reported screening rate for HCV was 22%; 7X higher than actually observed. The reasons most commonly cited for lack of screening were provider unawareness of screening guidelines (54%), and medically complex patients leaving inadequate time for preventative screening (51%). Conclusion: Despite the new CDC guidelines for screening HCV based on age-cohort (those born between 1945 and 1965), this single-center study demonstrates that HCV screening remains extremely suboptimal in primary care teaching clinics. Only 3% of eligible patients were tested; mostly due to risk factors or elevated LFT’s rather than age-cohort screening. The main barriers to screening appear to be lack of knowledge of the new screening guidelines as well as limited time to care for complex medical patients. With these issues in mind, additional components of this project will be to implement teaching and outreach programs for the healthcare providers and then reassess screening rates after intervention. If this program is successful in increasing screening rates, it will be implemented across our entire healthcare system.

Impact of Race/Ethnicity and Gender on HCV Screening and Prevalence Among US Veterans in Department of Veterans Affairs Care

We assessed HCV screening and prevalence among veterans and estimated the potential impact of complete birth cohort screening, accounting for the disparate HCV disease burden by race/ethnicity and gender. We used the Department of Veterans Affairs (VA) Corporate Data Warehouse to identify birth dates, gender, race/ethnicity, and laboratory tests for veterans with at least 1 VA outpatient visit in 2012. We calculated HCV screening rates, prevalence, and HCV infection incident diagnosis. Among 5,499,743 veterans, 54.7% had HCV screening through the VA. In more than 2.9 million veterans screened, HCV prevalence was 6.1% overall and highest among Blacks (11.8%), particularly Black men born in 1945 to 1965 (17.7%). HCV infection incident diagnosis in 2012 was 5.9% for men and 2.3% for women. An estimated additional 48,928 male veterans, including 12,291 Black men, and 1484 female veterans would potentially be identified as HCV infected with full birth cohort screening. HCV prevalence was markedly elevated among veterans born in 1945 to 1965, with substantial variation by race/ethnicity and gender. Full adoption of birth cohort screening may reveal substantial numbers of veterans with previously unknown HCV infection.