Hepatitis C Virus Education Research Articles

Patient Perceptions of Hepatitis C Screening and Diagnosis While in a County Jail.

Prior research in the Santa Clara County (SCC) Jail showed that knowledge of hepatitis C virus (HCV), perception of risk, and perceived coercion impacted participation in routine HCV screening; however, the experiences of patients undergoing screening were not assessed. The purpose of the study was to understand patient perceptions of undergoing routine viral hepatitis screening and receiving a diagnosis of HCV while incarcerated. A qualitative design was employed using semi-structured interviews of individuals newly diagnosed with HCV via routine screening in the SCC Jail between March and November 2023. The data were analyzed using thematic analysis. Of the 15 participants, most were within the 35 to 44 (47%) and 25 to 34 (40%) age ranges, were White or Caucasian (47%), and all were male. Nine themes emerged: (1) risk perception as a motivator for testing, (2) testing convenience to maintain health, (3) minimal to no prior testing experience, (4) mixed experiences testing in the jail, (5) negative to neutral reactions to HCV diagnosis, (6) intrinsic motivation to get treated, (7) basic HCV knowledge after diagnosis, (8) seamless treatment experience in the jail, and (9) barriers to continuing care upon release. The HCV screening process, including disclosure, education, and treatment initiation, was positively received among participants.

Understanding hepatitis C virus (HCV) health literacy and educational needs among people in prison to enhance HCV care in prisons

BackgroundHepatitis C virus (HCV) is a significant concern within prison populations. Provision of HCV testing and treatment for people in prison is expanding and a key component of global elimination efforts. Despite growing service availability, several challenges remain in HCV testing and treatment engagement during incarceration. The PIVOT study demonstrated that a ‘one-stop-shop’ intervention (point-of-care HCV RNA testing, Fibroscan®, nurse-led clinical assessment, and fast-tracked direct-acting antiviral prescription) enhanced HCV testing and treatment at a reception prison in Australia. Utilising Squier et al's Health Literacy Skills Framework, this analysis aimed to understand HCV health literacy and educational needs among people at a reception prison in Australia. MethodsSemi-structured interviews were conducted with twenty-four male PIVOT study participants. Purposive sampling ensured comparable representation of those with: 1) prior HCV testing history (standard pathology / no prior testing), and 2) injecting drug use history (IDU; ever / never). ResultsVaried HCV health literacy levels and educational needs were evident amongst people in prison. Whilst those with multiple incarceration episodes and IDU history (prior knowledge) appeared to have stronger HCV health literacy than those without, substantial gaps in HCV health literacy were evident. Knowledge of HCV transmission risks in prison was high, and most understood the importance of HCV testing and treatment in prison (comprehension), but ability to engage with HCV testing and treatment services, participation in safe injecting behaviours (health-related behaviours), and knowledge of re-infection and re-treatment, within the context of the prison environment, were suboptimal. There was a general desire for increased HCV education in prison. ConclusionGaps in HCV health literacy among people in prison were evident, indicating opportunities for improvement. A targeted HCV education program for people in prison, addressing the gaps identified in this analysis, may enhance HCV testing, treatment, and prevention by fostering stronger HCV health literacy among people in prison.

Increasing linkage to hepatitis C care following trauma-informed rehabilitation: An education and quality improvement project among women.

The on-going substance use crisis has led to unprecedented rates of hepatitis C virus (HCV) in Canada, with increasing positivity among women who use drugs (WWUD). Despite efforts to reduce barriers to HCV testing and treatment, follow-up remains a major issue. In this quality improvement project (QIP), we partnered with a short-stay trauma-informed residential drug treatment facility specifically for WWUD, to provide an engaging peer-led HCV education session, followed by low-barrier nurse and peer-led testing and treatment. We sought to evaluate these interventions, as well as determine what factors could improve engagement after women leave. The session was attended by 217 participants, 130 completed the survey and 153 opted into testing. Survey results indicated that participants were highly motivated to access general care as well as HCV testing and treatment. The most frequently reported barriers to testing and treatment werea previous negative test and being asymptomatic, respectively. Follow-up facilitators included a non-judgmental provider (88%), monetary incentives (67%), follow-up phone calls (77%), e-mails (66%) and text messages (58%). Of those who were RNA positive, 5 of 13 initiated treatment on-site. By using the results of the QIP in real-time, 6 of 13 were started after leaving the centre(one pending and one lost to follow-up). The implementation of co-localised peer-led testing and treatment for HCV, along with persistent follow-up efforts, led to increases in linkage to care and treatment. Co-localisation of testing and care with substance-use services, especially if residential, is a viable, low-barrier strategy for increasing linkage to care among WWUD.

Barriers and Facilitators to Hepatitis C Virus (HCV) Treatment for Aboriginal and Torres Strait Islander Peoples in Rural South Australia: A Service Providers’ Perspective

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination.

Cascade of Care for Hepatitis C Virus Infection Among Young Adults Who Inject Drugs in a Rural County in New Mexico.

Treatment for hepatitis C virus (HCV) infection is highly effective; however, people who inject drugs (PWID), the population most affected by HCV, may encounter barriers to treatment. We examined the cascade of care for HCV infection among young adult PWID in northern New Mexico, to help identify gaps and opportunities for HCV treatment intervention. Young adults (aged 18-29 y) who self-reported injection drug use in the past 90 days were tested for HCV antibodies (anti-HCV) and HCV RNA. We asked participants with detectable RNA to participate in an HCV education session, prior to a referral to a local health care provider for treatment follow-up, and to return for follow-up HCV testing quarterly for 1 year. We measured the cascade of care milestones ranging from the start of screening to achievement of sustained virologic response (SVR). Among 238 participants, the median age was 26 years and 133 (55.9%) were men. Most (90.3%) identified as Hispanic. Of 109 RNA-positive participants included in the cascade of care assessment, 84 (77.1%) received their results, 82 (75.2%) participated in the HCV education session, 61 (56.0%) were linked to care through a medical appointment, 27 (24.8%) attended the HCV treatment appointment, 13 (11.9%) attended their follow-up appointment, 6 (5.5%) initiated treatment, 3 (2.8%) completed treatment, and 1 (0.9%) achieved SVR. We observed a steeply declining level of engagement at each milestone step of the cascade of care after detection of HCV infection, resulting in a suboptimal level of HCV treatment and cure. Programs that can streamline testing and expand access to treatment from trusted health care providers are needed to improve the engagement of PWID in HCV treatment.

The role of community pharmacies in the HIV and HCV care continuum

IntroductionIn 2019, there were over 1.1 million people living with human immunodeficiency virus (HIV) and 2.4 million people living with hepatitis C virus (HCV) in the United States. One in seven (14%) are unaware of their HIV infection and almost half of all HCV infections are undiagnosed. People with unstable housing are disproportionately affected by HIV and HCV. The present study will evaluate interventions by community pharmacists that may reduce HIV and HCV transmission and promote linkage to care. MethodsThis study was conducted in an independent community pharmacy in Spokane, Washington. Eligible study participants were walk-in patients of the pharmacy, over the age of 18, and experiencing homelessness. Pharmacy patients were excluded if they had a history of HIV or HCV diagnosis, received a screening for HIV or HCV in the last six months or were unable to give informed consent. The intervention included administration of HIV and HCV point-of-care testing (POCT) using a blood sample, risk determination interview, comprehensive HIV and HCV education, and personalized post-test and risk mitigation counseling followed by referral to partnering health clinics. ResultsFifty participants were included in the final data analysis. Twenty-two participants (44%) had a reactive HCV POCT, and one participant had a reactive HIV POCT. Of the 94% of participants who reported illicit drug use, 74% reported injection drug use. Seventy-six percent (n = 38) qualified for PrEP. Pharmacist referrals were made for 28 participants and 71% were confirmed to have established care. ConclusionIndividuals experiencing homelessness are at an increased risk for acquiring HIV and HCV due to risky sexual behaviors and substance misuse. PrEP is underutilized in the U.S. and pharmacist involvement in the HIV and HCV care continuum may have a significant impact in improving linkage and retention in care of difficult to treat populations.

Pediatric Hepatitis C Quality Improvement Project Improves Healthcare Access.

Incidence of hepatitis C virus (HCV) infection is increasing in women of reproductive age, leading to increased prevalence of HCV infection in children via vertical transmission. This quality improvement (QI) project aimed to increase referrals to and appointments scheduled with a specialty pediatric gastroenterology HCV clinic and the number of eligible children with HCV who completed treatment. From July 2020 to August 2021, the QI team designed a project using the Model for Improvement and completed Plan Do Study Act cycles to test change ideas to improve HCV awareness and education for medical providers and families; standardize the referral process; track patients; increase clinic capacity; and connect families with community resource care coordination. Referrals to the pediatric HCV clinic, appointments scheduled, no shows, and treatment follow-up were tracked during the project period and a comparison timeframe from July 2019 to June 2020. There were improvements in several measures during the project period versus the comparison timeframe, with 80 versus 48 referrals received (66% increase), 115 versus 59 scheduled clinic visits (95% increase), and 7 versus 5 treatment completers (40% increase), along with a small (7%) decline in the proportion of scheduled clinic visits that were no shows. Application of QI methodology increased medical provider and caregiver awareness and engagement in accessing HCV healthcare available for at-risk children. More QI efforts should be accelerated to identify best practices amidst a nationwide HCV epidemic.

Results of a Model of Delivering Hepatitis C Care in a Homeless Metropolitan Population in England.

Given the hepatitis C virus (HCV) burden and despite curative treatments, more efforts focused on scaling-up testing and treatment in homeless populations are needed. This project aimed to implement education and flexible on-site HCV testing, treatment, and follow-up for a homeless population in south London and to evaluate engagement, therapy initiation, and cure rates. A mobile unit (van) for on-site HCV education, screening, treatment, and follow-up was placed on the street in a well-known homeless population areas from January 2018 to September 2021. Homeless was defined as living in temporary housing (hostel/hotel-based) or living on the street (street-based). Sociodemographic status, risk factors, comorbidities, concomitant medication, and data related with HCV treatment were recorded. Univariable and multivariable modeling were performed for treatment initiation and sustained virological response (SVR). Nine hundred forty homeless people were identified and 99.3% participated. 56.2% were street-based, 243 (26%) tested positive for HCV antibody, and 162 (17.4%) were viremic. Those with detectable HCV RNA had significantly more frequent psychiatric disorders, active substance use disorders, were on opioid agonist treatment, had advanced fibrosis, and had lower rates of previous treatment in comparison with undetectable HCV RNA. Overall treatment initiation was 70.4% and SVR was 72.8%. In the multivariable analysis, being screened in temporary housing (odds ratio [OR] 3.166; P = 0.002) and having opioid agonist treatment (OR 3.137; P = 0.004) were positively associated with treatment initiation. HCV treatment adherence (OR 26.552; P < 0.001) was the only factor associated with achieving SVR. Promoting education and having flexible and reflex mobile on-site testing and treatment for HCV in the homeless population improve engagement with the health care system, meaning higher rates of treatment initiation and SVR. However, street-based homeless population not linked with harm reduction services are less likely to initiate HCV treatment, highlighting an urgent need for a broad health inclusion system.

A qualitative investigation of organizational challenges and facilitators to screening individuals experiencing homelessness for hepatitis C virus (HCV) in Houston, Texas.

BackgroundIndividuals experiencing homelessness may be at a disproportionately high risk for hepatitis C (HCV) because they may be more likely to engage in HCV risk behaviors. Community organizations that provide services to these vulnerable individuals can effectively screen, diagnose, and navigate them into HCV care. However, screening people experiencing homelessness for HCV at such organizations is limited by various challenges that remain understudied, including budgetary considerations and strategies to improve teamwork and communication. Accordingly, this study investigated the organizational challenges and facilitators to HCV screening of individuals experiencing homelessness as reported by homeless services providers.MethodsStaff (N = 21) at two community organizations in Houston, Texas, completed an interviewer-administered survey and a semi-structured interview in August 2020 to assess the challenges and facilitators to screening people experiencing homelessness for HCV. Interviews were coded, and a thematic analysis was conducted to identify challenges as well as facilitators to HCV screening among individuals experiencing homelessness.ResultsAlmost half of participants were employed in social services (42.86%; n = 9), while the remainder were employed in management/administration and health services. Barriers to HCV screening included funding, logistics, and resource-related challenges; and limited communication and collaboration around HCV screening. Facilitators to HCV screening included providing HCV education and training for all staff; and incentivizing, formalizing, and funding HCV screening.ConclusionsCommunity organizations can help minimize barriers to HCV screening among individuals experiencing homelessness by providing staff with training specific to HCV, client education around HCV and the screening process, and providing clients with incentives for participation, as well as by maximizing community and clinic partnerships to provide linkage to care and services to this high-risk population.

Hepatitis C Epidemiology in a Large Urban Jail: A Changing Demographic.

Nearly 1 in 3 people with hepatitis C virus (HCV) infection pass through the criminal justice system annually; the system is a crucial location for HCV screening, education, and linkage to care. We aimed to (1) determine the prevalence and incidence of HCV antibody positivity and (2) evaluate the demographic characteristics of people with HCV in a large urban jail. We offered universal opt-out HCV testing to any person undergoing a routine blood test at the Dallas County Jail from June 2015 through December 2019 (N = 14 490). We extracted data on demographic characteristics from the electronic medical record and collected data on risk factors from people with HCV antibody positivity. We performed univariate and multivariate analyses. The prevalence of HCV antibody positivity was 16.7%; the incidence was 13.5 cases per 1000 person-years. HCV antibody positivity was significantly associated with older age (P < .001), female sex (P = .004), non-Hispanic White race versus non-Hispanic Black race (P < .001), and being released to prison versus not (P < .001). Among people born after 1965, those who were HCV antibody-positive were more frequently non-Hispanic White and Hispanic women, whereas among those born in 1965 or before, those who were HCV antibody-positive were more frequently non-Hispanic Black men. The high prevalence and incidence of HCV antibody positivity in a large county jail argue for routine, universal HCV testing and prevention counseling in criminal justice settings. Changing demographic characteristics mirror those of the national injection drug use epidemic and shed insight into designing interventions for risk reduction, education, linkage to care, and treatment.

Formal Hepatitis C Education Increases Willingness to Receive Therapy in an On-site Shelter-Based HCV Model of Care in Persons Experiencing Homelessness.

BackgroundThe objective of this study was to evaluate the effectiveness of formal hepatitis C virus (HCV) education on engagement in therapy in persons experiencing homelessness in an on-site shelter-based model of care. As policies to eliminate Medicaid access restrictions to HCV treatment are expanded, patient education is paramount to achieving HCV elimination targets in difficult-to-engage populations including persons experiencing homelessness.MethodsThis prospective study was conducted at 4 shelters in San Francisco and Minneapolis from August 2018 to January 2021. Of the 162 HCV Ab–positive participants, 150 participated in a 30-minute HCV education session. Posteducation changes in knowledge, beliefs, barriers to care, and willingness to accept therapy scores were assessed.ResultsFollowing education, knowledge scores (mean change, 4.4 ± 4.4; P < .001) and willingness to accept therapy (70% to 86%; P = .0002) increased. Perceived barriers to HCV care decreased (mean change, –0.8 ± 5.2; P = .001). Higher baseline knowledge was associated with lesser gain in knowledge following education (coef., –0.7; P < .001). Posteducation knowledge (odds ratio, 1.2; P = .008) was associated with willingness to accept therapy.ConclusionsAn HCV educational intervention successfully increased willingness to engage in HCV therapy in persons experiencing homelessness in an on-site shelter-based HCV model of care.

Shelter-Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness.

Hepatitis C virus (HCV) prevalence is high among people experiencing homelessness, but barriers to scaling up HCV testing and treatment persist. We aimed to implement onsite HCV testing and education and evaluate the effectiveness of low‐barrier linkage to HCV therapy among individuals accessing homeless shelters. HCV rapid testing was performed at four large shelters in San Francisco (SF) and Minneapolis (MN). Sociodemographic status, HCV risk, barriers to testing, and interest in therapy were captured. Participants received information about HCV. Those testing positive underwent formal HCV education and onsite therapy. Multivariable modeling assessed predictors of receipt of HCV therapy and sustained virologic response (SVR). A total of 766 clients were tested. Median age was 53.7 years, 68.2% were male participants, 46.3% were Black, 27.5% were White, 13.2% were Hispanic, and 57.7% had high school education or less; 162 (21.1%) were HCV antibody positive, 107 (66.0%) had detectable HCV RNA (82.1% with active drug use, 53.8% history of psychiatric illness), 66 (61.7%) received HCV therapy, and 81.8% achieved SVR. On multivariate analysis, shelter location (MN vs. SF, odds ratio [OR], 0.3; P = 0.01) and having a health care provider (OR, 4.1; P = 0.02) were associated with receipt of therapy. On intention to treat analysis, the only predictor of SVR when adjusted for age, sex, and race was HCV medication adherence (OR, 14.5; P = 0.01). Conclusion: Leveraging existing homeless shelter infrastructure was successful in enhancing HCV testing and treatment uptake. Despite high rates of active substance use, psychiatric illness, and suboptimal adherence, over 80% achieved HCV cure. This highlights the critical importance of integrated models in HCV elimination efforts in people experiencing homelessness that can be applied to other shelter settings.

Adherence to Hepatitis C Therapy in a Shelter-Based Education and Treatment Model Among Persons Experiencing Homelessness.

Medication adherence is a common reason for treatment deferment in persons experiencing homelessness. We evaluated adherence to hepatitis C virus (HCV) therapy following HCV education in a shelter-based care model. Prospective study conducted at 4 homeless shelters in Minneapolis, Minnesota and San Francisco, California from November 2018 to January 2021. Sixty-three patients underwent HCV education and treatment. Multivariable modeling evaluated factors associated with (1) medication and (2) overall (composite score of medication, laboratory, and clinic visit) adherence. Median age was 56 years; 73% of participants were male, 43% were Black, 52% had psychiatric illness, and 81% used illicit drugs and 60% used alcohol in the past year. Following education, 52% were extremely confident in their ability to be adherent to HCV therapy. Medication adherence by patient and provider report was 88% and 48%, respectively, and 81% achieved HCV cure. Active alcohol use was associated with less confidence in medication adherence (43% vs 78%, P = .04). Older age was positively (coefficient = 0.3) associated with overall adherence to HCV treatment whereas prior therapy was associated with both medication (odds ratio, 0.08) and overall treatment (coefficient = -0.87) nonadherence. Despite imperfect adherence, sustained virologic response rates were still high. Expanding opportunities to treat persons experiencing homelessness in a structured and supportive setting is critical to HCV elimination efforts.

Hepatitis C virus screening at a Veterans Administration Hospital in New York City

Asymptomatic hepatitis C virus (HCV) infection has the highest prevalence in "baby boomers" born in 1945 through 1965. New York State mandates that all persons born during this period be screened at least once for hepatitis C. Military veteran HCV screening is often missed during primary care visits. After baseline screening, provider education with and without an HCV education dashboard of information in the Electronic Medical Record system was used to determine if screening proportions could be improved. The Chi-square and Z-test for independent proportions compared after with before education screening. The odds ratio compared after versus before screening odds. Two interventions were tested. One was provider education with a 30-minute lecture. The second was the lecture with addition of an HCV education computer dashboard. The Chi-square test and Z-test comparing the month immediately after provider education was significant for increased screening (p < .01) compared with baseline. There was a 2.04-fold (95% confidence interval, 1.31-3.20) greater odds of screening in the month after education. If two or more months went by after education, the effect of education no longer improved screening proportions. Provider education plus the use of HCV education dashboard did not improve screening from baseline to the month immediately after screening (p = .95). Provider education significantly improved HCV screening the month immediately after education, then regressed toward baseline. Adding an HCV education dashboard to education did not improve screening. To maintain elevated screening proportions, provider screening education must be reinforced on a frequent basis for sustained effect.

Hepatitis C-Related Mortality Among American Indian/Alaska Native Persons in the Northwestern United States, 2006-2012.

American Indian and Alaska Native (AI/AN) persons are commonly misclassified in epidemiologic and administrative data sets. The race-corrected hepatitis C virus (HCV)-related mortality rate among AI/AN persons in the Northwest United States (Idaho, Oregon, and Washington State) is unknown. We quantified the disparity in HCV-related mortality between AI/AN persons and non-Hispanic white (NHW) persons in the Northwest during 2006-2012 after correcting misclassified AI/AN race. After conducting probabilistic record linkage between death records and the Northwest Tribal Registry, we calculated HCV-related mortality rates for AI/AN and NHW persons by using National Center for Health Statistics bridged-race estimates standardized to the US 2000 standard population. The 2006-2012 aggregate age-adjusted HCV-related mortality rate per 100 000 population in the Northwest was 19.6 (95% confidence interval [CI], 17.3-22.2) for AI/AN persons and 5.9 (95% CI, 5.7-6.1) for NHW persons (rate ratio [RR] = 3.3; 95% CI, 3.0-3.8). The disparity was larger among females (RR = 4.6; 95% CI, 3.8-5.5) than among males (RR = 2.9; 95% CI, 2.5-3.4). The disproportionate rate of HCV-related mortality among AI/AN persons in the Northwest highlights the need to expand HCV education, screening, and treatment among this population.

Hepatitis C Competency and Outreach of Occupational Health Nurses.

In the United States, approximately one half of individuals with chronic hepatitis C virus (HCV) are not aware of their status. Current HCV treatment is highly successful and is associated with a decrease in all-cause mortality. Occupational health nurses (OHNs) are often the sole health care providers at worksites and have a unique opportunity to provide HCV education, screening, and linkage to care. This project measured changes in OHN HCV competency and outreach, and identified barriers to screening. In June 2017, Survey 1 was emailed to 3,414 American Association of Occupational Health Nurse (AAOHN) members. For HCV competence, HCV knowledge and confidence in educating and counseling employees regarding HCV were assessed. HCV outreach and barriers to screening were identified. The HCV educational campaign launched in October 2017 with a webinar, a webpage/toolkit, and educational emails. Survey 2 was emailed in January 2018 to assess for changes in HCV competency and outreach. A total of 445 OHNs responded to Survey 1, and 111 completed both surveys, and participant demographics represented AAOHN membership base (95% female, mean age 56.4). The average HCV knowledge pretest score was 76% and posttest score was 77%. Confidence in educating/counseling employees about HCV increased from 2.6 to 2.9 (on a 1-5 scale; p = .052). Higher pretest scores were associated with bachelor's degree (BS/BA) education or above, greater confidence in HCV education/counseling of employees, and HCV education participation within the prior 12 months. There are ongoing HCV learning needs for OHNs and greater opportunities for HCV outreach in worksites.

Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia

BackgroundThe prevalence of hepatitis C virus (HCV) has been reported to be high among people experiencing homelessness. People who are homeless often have multiple needs that may take precedence over HCV testing and treatment. We quantitatively evaluated the outcomes of a service providing HCV treatment to people attending homeless services. MethodsClients attending homeless services were referred to a nurse specialising in HCV-related care. The nurse provided HCV testing, education and case-management while prescriptions were provided by an affiliated doctor. Logistic regression was used to explore factors associated with treatment commencement. ResultsFifty-two clients referred (78%) underwent testing, thirty-nine were HCV-RNA positive among whom 18 (46%) reported sleeping rough and 29 (74%) reported injecting drug use; 66% had injected less than three months ago. Twenty-four (62%) clients commenced treatment, of whom thirteen (54%) had a sustained virological response test; all were cured. Treatment commencement was lower among people who reported sleeping rough (aOR 0.15, 95%CI 0.029-0.73). There was no difference in treatment commencement based on injecting drugs (aOR 1.06, 95%CI 0.21–5.2). ConclusionMost clients’ commenced treatment and the majority were successfully cured using a dedicated nursing service. Clients who reported sleeping rough may still face personal and/or system level barriers to HCV treatment.

2237. Validity of Self-Reported HCV Status Among Justice-Involved Persons Living with HIV

BackgroundThe prevalence of hepatitis C virus (HCV) and human immunodeficiency virus (HIV)-1 co-infection among justice-involved persons is high and HCV health literacy is low. The validity of self-reported HCV status in this population has important implications for HCV testing and education programs inside correctional facilities and in the community after release, yet its assessment is limited.MethodsHIV-positive justice-involved persons from the District of Columbia were enrolled into a study evaluating a health intervention for improved HIV treatment adherence and linkage to community-based HIV care. Participants completed a comprehensive baseline assessment that included self-reported HCV status, which we compared with lab-confirmed status among self-reported HCV(+) and HCV(−) participants. Overall agreement between reported and lab-confirmed status for all participants was assessed using Cohen’s Kappa statistic. Banked plasma specimens were tested for HCV antibody (Ab); Ab-positive or equivocal specimens were tested for HCV RNA levels.ResultsOf 110 participants, 103 were available for HCV testing and were included in analyses. Twenty participants (19%) self-reported being HCV(+) of which 11 (55%) were HCV Ab(+), all of who were HCV RNA(+). Nine participants reported being HCV(+) but were HCV(−) [8 were HCV Ab(−) and one had an equivocal Ab result which was HCV RNA(−)]. Among the 83 participants not reporting HCV infection, 80 were HCV Ab(−), one had an equivocal Ab result [HCV RNA(−)], and two (both women) were HCV Ab(+) and HCV RNA(+). Overall, self-report and lab results had a moderate agreement (Cohen’s Kappa = 0.60) and lab-confirmed prevalence of RNA(+) was 13%.ConclusionThe validity of self-reported HCV status among justice-involved persons living with HIV was moderate. Only one-half of persons who reported HCV infection were confirmed to be HCV infected. In addition, two women (2.4%) who did not report HCV infection were found to be infected. These findings support the need for expanded HCV-specific testing, counseling and education among justice-involved persons, with focused attention on justice-involved women who may be at particularly high risk for undiagnosed HCV.Disclosures All authors: No reported disclosures.

Integrating comprehensive hepatitis C virus care within a residential substance use disorder treatment program

Background and aimsAlthough central to the hepatitis C virus (HCV) epidemic, many patients with both substance use disorders (SUD) and HCV have difficultly engaging in treatment for either condition. To facilitate HCV care in Veterans with active SUD, a comprehensive HCV screening, education, referral, and treatment program was integrated into a VA residential SUD treatment program. MethodsEvaluation of HCV screening, education, referral, and treatment initiative among admissions to a residential SUD treatment program from December 2014 to April 2018. ResultsTo date, 97.49% (582/597) of admissions to the program have been screened for HCV infection, with 12.71% (74/582) of the cases confirmed HCV-positive, and 100% (74/74) of the positive cases being connected or re-connected to the infectious disease clinic for further evaluation and, if appropriate, to begin HCV pharmacotherapy. Importantly, 18.92% (14/74) of the HCV-positive cases were newly diagnosed and would have likely gone undetected without this program. Of the HCV-positive cases, 78.38% (58/74) have received pharmacotherapy, with a sustained virologic response rate of 82.76% (48/58). ConclusionsIntegrating comprehensive HCV care within a residential SUD treatment program using a collaborative care model can substantially increase the detection of previously undiagnosed infections, facilitate linkage to care, and promote HCV treatment uptake among HCV-infected Veterans with SUD.

Proper patient education improves hepatitis C patients' disease-related knowledge and antiviral treatment acceptance in rural China

Objective: To evaluate the affect of hepatitis C virus (HCV) education in chronic hepatitis C patients' disease related knowledge and antiviral treatment acceptance in rural china. Methods: Rural HCV patients of attended CHC project of HCV education. Doctor delivered subsequent interactive lecture, and patients completed pre- and post-education questionnaires before and after taking the lectures. Results: 151 CHC patients were included. Mean age was 57.3 years old, 50.3% were male, 51.0% of the students had primary school education or illiterate, and 76.2% had a monthly income below RMB 3,000. 98.0% of patients defined their baseline HCV knowledge as "nothing" or "a little bit". A multivariate analysis reveled baseline knowledge scores were associated with age and household income. After education, mean knowledge score (range: 0-28) increased from 13.1 to 23.0 (P < 0.001) and average percent of patients with correct answers from the topic rose from 46.8% to 82.1% (P < 0.001), and patients' antiviral treatment acceptance increased from 33.9% to 65.6% (P < 0.001). Conclusion: A rural Chinese patients had less education, HCV education delivered on the preferred format of patients substantially improved hepatitis C patients' disease-related knowledge and antiviral treatment acceptance in rural china.