Increase Hepatitis C Virus Screening Research Articles

Abstract IA045: Hepatitis C virus (HCV) screening and treatment in South Texas US-Mexico border persistent poverty counties

Abstract Background: Hepatitis C Virus (HCV) is a major risk factor for Hepatocellular carcinoma (HCC), early screening of HCV is essential for the prevention of HCC. Other risk factors for cancer are those associated with poverty including low socioeconomic status and lack of access to health care. These risk factors are prominent among hispanic populations who have higher rates of liver cancer. In 2021, Hispanic liver cancer (incidence and mortality) was almost doubled as compared to non-Hispanic whtes. In Texas, the incidence of liver cancer is higher for Hispanics and particularly for those living in South Texas. Methods: We implemented an multi-component intervention (STOP-HCC-HCV) to increase access to HCV screening and treatment in two clinic systems predominantly serving low-income Hispanic ommunities in three South Texas persistent poverty counties. We used a Hybrid type 1 implementation effectiveness study design to evaluate the program's impact using both qualitative and quantitative data. Results: Using the RE-AIM framework, we increased HCV screening rates from 10% in 2021, to 78% in 2023 among adults 18-56 years of age. We successfully naviagted uninsured patients to treatment and cure and have 100% success rate for ordering Direct Acting Antivirals. Conclusion: Using a multi-component intervention, and decreasing barriers to healthcare increased HCV screening and treatment to ultimetly decrease cancer health disparities among vulnerable populations living in persistent poverty counties. Citation Format: Bertha E. Flores, Juan Guerrero, Raudel Bobadilla, Catherine K. Craven. Hepatitis C virus (HCV) screening and treatment in South Texas US-Mexico border persistent poverty counties [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA045.

Collaborative Referral Model for Hepatitis C Screening and Treatment in a Remote Mountainous Region of Taiwan during the COVID-19 Pandemic.

Community-based screening for the hepatitis C virus (HCV) decreased during the COVID-19 pandemic. We developed a collaborative referral model between a primary clinic (Liouguei District Public Health Center, LDPHC) and a tertiary referral center to increase HCV screening and treatment uptake in a mountainous region of Taiwan. Once-in-a-lifetime hepatitis B and C screening services established by the Taiwan National Health Insurance were performed at LDPHC. Antibody-to-HCV (anti-HCV)-seropositive patients received scheduled referrals and took a shuttle bus to E-Da hospital for HCV RNA testing on their first visit. Direct-acting antiviral agents (DAAs) were prescribed for HCV-viremic patients on their second visit. From October 2020 to September 2022, of 3835 residents eligible for HCV screening in Liouguei District, 1879 (49%) received anti-HCV testing at LDPHC. The overall HCV screening coverage rate increased from 40% before referral to 69.4% after referral. Of the 79 anti-HCV-seropositive patients, 70 (88.6%) were successfully referred. Of the 38 HCV-viremic patients, 35 (92.1%) received DAA therapy, and 32 (91.4%) achieved sustained virological response. The collaborative referral model demonstrates a good model for HCV screening and access to care and treatment in a Taiwan mountainous region, even during the COVID-19 pandemic. Sustained referral is possible using this routine referral model.

Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care

Chronic infection with hepatitis C virus (HCV) results in an increased risk of cirrhosis and hepatocellular carcinoma (HCC). Only 15% of baby boomers (born 1945–1965) have ever been screened. We aimed to develop a multilevel intervention to increase HCV screening for baby boomers in a primary care setting. This study included two phases: intervention development (phase 1) and feasibility testing (phase 2). In phase 1, we partnered with a Community Advisory Board and a Provider Advisory Board to develop a multilevel intervention to increase HCV screening to be delivered to both providers and patients in primary care. Phase 2 assessed intervention feasibility, acceptability, and usability by conducting Concurrent Think Aloud (CTA) interviews and surveys using previously validated scales with patients (n = 8) and providers (n = 7). Phase 1 results: The patient-level intervention included a mailed reminder letter and CDC pamphlet and a 7-min in-clinic educational video. The provider-level intervention included a 30-min educational session and monthly performance feedback e-mails. Phase 2 results: Qualitatively, both the patient and provider-level intervention were feasible, acceptable, and usable by the target audiences. Quantitatively, on a 1–4 scale, the range of patient-level scores was 3.00–4.00 and provider level was 3.50–4.00 for feasibility, acceptability, and usability. This intervention could improve HCV screening among a high-risk population and therefore reduce HCV-related morbidity and mortality. This project developed a feasible, acceptable, and usable multilevel intervention aimed at increasing HCV screening in primary care.

Medicaid Hepatitis C Virus Treatment Policies: Impact on Testing and Treatment in the Commercially Insured

A total of 23 state Medicaid programs continue to restrict hepatitis C virus (HCV) medication access by liver disease or substance-use criteria, creating obstacles to HCV elimination and significant care disparities. Because public insurers often set precedents for private insurer coverage and clinician practice patterns, this study sought to analyze whether spillover occurs from state Medicaid HCV treatment restrictions to HCV screening and treatment rates in commercially insured individuals. Investigators analyzed 2014‒2017 commercial claims data across 48 U.S. states (721,961,965 person-months) and used an interrupted times series design to compare hepatitis C virus screening and treatment rates before and after state Medicaid HCV treatment policy changes, adjusting for state-level random effects, Medicaid expansion status, and state drug overdose incidence rates, in states that relaxed Medicaid policy over the study period. Analysis occurred during 2019‒2021. Hepatitis C virus screening rates among commercially insured individuals increased after the corresponding state Medicaid program relaxed HCV treatment policy. Among states that changed Medicaid policy, those that reduced fibrosis or both fibrosis and abstinence restrictions experienced increased HCV screening rates by the study end compared with states that changed only abstinence restrictions (rate ratio=1.29; 95% CI=1.15, 1.44; and rate ratio=1.32; 95% CI=1.17, 1.50, respectively). Similar patterns did not occur in HCV treatment rates, which declined after 2015 across groups. These data show that HCV screening rates increased among commercially insured individuals after the removal of Medicaid HCV treatment restrictions in the same state. This suggests that Medicaid treatment policies can spill over to affect health outcomes among commercially insured populations.

Do patients at high risk for Hepatitis C receive recommended testing? A retrospective cohort study of statewide Medicaid claims linked with OneFlorida clinical data.

Hepatitis C virus (HCV) infection is a leading risk factor for hepatocellular carcinoma.We employed a retrospective cohort study design and analyzed 2012–2018 Medicaid claims linked with electronic health records data from the OneFlorida Data Trust, a statewide data repository containing electronic health records data for 15.07 million Floridians from 11 health care systems. Only adult patients at high-risk for HCV (n = 30,113), defined by diagnosis of: HIV/AIDS (20%), substance use disorder (64%), or sexually transmitted infections (22%) were included. Logistic regression examined factors associated with meeting the recommended sequence of HCV testing.Overall, 44.1% received an HCV test. The odds of receiving an initial test were significantly higher for pregnant females (odds ratio [OR]1.99; 95% confidence interval [CI] 1.86–2.12; P < .001) and increased with age (OR 1.01; 95% CI 1.00–1.01; P < .001).Among patients with low Charlson comorbidity index (CCI = 1), non-Hispanic (NH) black patients (OR 0.86; 95% CI 0.81–0.9; P < .001) had lower odds of getting an HCV test; however, NH black patients with CCI = 10 had higher odds (OR 1.41; 95% CI 1.21–1.66; P < .001) of receiving a test. Of those who tested negative during initial testing, 17% received a second recommended test after 6 to 24 months. Medicaid-Medicare dual eligible patients, those with high CCI (OR 1.14; 95% CI 1.11–1.17; P < .001), NH blacks (OR 1.93; 95% CI 1.61–2.32; P < .001), and Hispanics (OR 1.49; 95% CI 1.08–2.06; P = .02) were significantly more likely to have received a second HCV test, while pregnant females (OR 0.71; 95% CI 0.57–0.89; P = .003), had lower odds of receiving it. The majority of patients who tested positive during the initial test (97%) received subsequent testing.We observed suboptimal adherence to the recommended HCV testing among high-risk patients underscoring the need for tailored interventions aimed at successfully navigating high-risk individuals through the HCV screening process. Future interventional studies targeting multilevel factors, including patients, clinicians and health systems are needed to increase HCV screening rates for high-risk populations.

Hepatitis C Virus Screening: Factors Associated With Test Completion in a Large Academic Health Care System.

In 2012, onetime hepatitis C virus (HCV) screening was recommended for all baby boomers (people born during 1945-1965) in the United States, but only 4.0%-12.9% of baby boomers have ever had a screening ordered by a health care provider. This study examined the HCV screening prevalence among adult patients in a large academic health care system and assessed factors associated with the completion of screening when ordered for baby boomers. We defined HCV screening completion as the completion of an HCV antibody test when it was ordered. We used electronic health records to examine HCV screening completion rates among adults (N = 106 630) from August 1, 2015, through July 31, 2020, by birth cohort. Among baby boomers whose health care provider ordered HCV screening, we examined frequency and percentages of HCV screening completion by sociodemographic and clinical characteristics. We conducted univariate and multivariable logistic regression analyses to assess factors associated with HCV screening completion among baby boomers. During the study period, 73.0% of baby boomers completed HCV screening when it was ordered. HCV completion did not differ by sex or race and ethnicity among baby boomers. Baby boomers with Medicare supplemental health insurance compared with commercial health insurance (adjusted odds ratio [aOR] = 1.87) and those seeing only advanced practice professionals compared with specialty care physicians (aOR = 2.24) were more likely to complete HCV screening when it was ordered. Noncompletion of HCV screening is one of many barriers along the HCV treatment continuum. Our findings suggest a need for interventions targeting systems, health care providers, and patients to increase HCV screening rates in the United States.

Screening at a Federally Qualified Health Center in the Midwest for Hepatitis C Among People Who Inject Drugs, 2019-2020.

IntroductionHepatitis C virus (HCV) infection is a public health epidemic. People who inject drugs (PWID) are at high risk for transmitting and contracting HCV. The objective of this study was to assess the effectiveness of a multifaceted intervention at a federally qualified health center in the US Midwest to improve HCV screening rates among PWID.MethodsA prospective quality improvement initiative was conducted to increase the proportion of PWID screened for HCV. Inclusion criteria consisted of being seen by a primary care provider from April 16, 2019, through February 28, 2020, being aged 18 years or older, and confirmation of intravenous drug use. PWID status was confirmed by reviewing electronic health records. The multifaceted intervention consisted of educational sessions for the health care team and workflow changes. We analyzed the proportion of patients screened preintervention and postintervention by using χ2 tests.ResultsOf 742 patients who met the inclusion criteria, the proportion of PWID screened preintervention was 59.6% (n = 329) and the proportion of PWID screened postintervention was 65.1% (n = 283), increasing the screening rate by 5.5 percentage points. A χ2 test of homogeneity indicated a significant relationship between the preintervention and postintervention periods, and screening outcomes (P < .001).ConclusionThis multifaceted intervention to increase HCV screening resulted in a modest increase in the proportion of PWID screened. Consistent and health care system–wide screening approaches are needed to optimize the potential of HCV treatment and cure options now available.

84539 Developing a Multilevel Intervention to Increase Hepatitis C Virus Screening of Baby Boomers in Primary Care

ABSTRACT IMPACT: This research will improve human health by increasing screening for hepatitis C virus, thereby decreasing morbidity and mortality from hepatitis C-related disease. OBJECTIVES/GOALS: The worldwide incidence of liver cancer increased 75% from 1990 to 2015 due, in part, to chronic hepatitis C virus (HCV) infection. Individuals born 1945-1965 (baby boomers) have five times the prevalence of HCV infection compared to other birth cohorts, but fewer than 15% of this cohort have ever been screened. METHODS/STUDY POPULATION: Effective interventions to increase HCV screening among baby boomers are urgently needed. In partnership with a provider advisory board and a community advisory board, we will develop a multilevel intervention designed to increase HCV screening that will be delivered to both providers and patients in primary care. We will assess whether the intervention is feasible, acceptable, and usable from the perspectives of the target audiences (providers and patients) by conducting Concurrent Think Aloud (CTA) interviews with eight patients and eight providers. RESULTS/ANTICIPATED RESULTS: While the specific content of both intervention components will not be finalized until the completion of the study, we envision that the provider-level intervention will likely include a one-time educational session and monthly performance feedback provided via e-mail reporting each provider’s HCV screening rates. The patient-level intervention may include mailed reminder letters prior to a scheduled clinic visit informing them that HCV screening is recommended and a tablet-based in-clinic computer program to educate, engage, and activate patients to be screened. DISCUSSION/SIGNIFICANCE OF FINDINGS: The goals of this project are to: 1) develop an acceptable, feasible, and usable multilevel intervention aimed at increasing HCV screening in primary care; and 2) understand the relationship between the intervention components and HCV screening; and 3) reduce HCV-related morbidity and mortality.

Randomized Clinical Trial of Inreach With or Without Mailed Outreach to Promote Hepatitis C Screening in a Difficult-to-Reach Patient Population.

Hepatitis C virus (HCV) treatment can significantly reduce the risk of liver-related mortality; however, many patients remain unaware of their infection in clinical practice. The aim of this study is to compare the effectiveness of inreach, with and without mailed outreach, to increase HCV screening and follow-up in a large, difficult-to-reach patient population. We conducted a pragmatic randomized clinical trial from August 2018 to May 2019 in a large safety-net health system. Patients born between 1945 and 1965 were randomly assigned (1:1) to inreach with an electronic health record reminder to providers (n = 6,195) or inreach plus mailed HCV screening outreach (n = 6,191) to complete HCV antibody screening. Outreach also included processes to promote HCV RNA testing among those with a positive HCV antibody and linkage to care among those with positive HCV RNA. The primary outcome was completion of HCV antibody testing within 3 months of randomization (ClinicalTrials.gov NCT03706742). We included 12,386 eligible patients (median age 60 years; 46.5% Hispanic, 33.0% Black, and 16.0% White). In intent-to-treat analyses, HCV screening completion was significantly higher among inreach-plus-outreach patients than inreach-alone patients at 3 months (14.6% vs 7.4%, P < 0.001) and 6 months (17.4% vs 9.8%, P < 0.001) after randomization. Among those who completed HCV screening within 6 months, a higher proportion of inreach-plus-outreach patients with positive antibody results completed RNA testing within 3 months than inreach-alone patients (81.1% vs 57.1%, respectively, P = 0.02); however, linkage to care within 3 months of HCV infection confirmation did not significantly differ between the 2 groups (48.1% vs 75.0%, respectively, P = 0.24). Among difficult-to-reach patients, a combination of inreach and mailed outreach significantly increased HCV screening compared with inreach alone. However, HCV screening completion in both arms remained low, highlighting a need for more intensive interventions.

Improving Hepatitis C Screening in the Primary Care Outpatient Setting for Individuals Belonging to the Birth Cohort 1945-1965

Hepatitis C virus (HCV) affects millions of individuals in the United States. Because of the asymptomatic nature of early illness, many individuals infected with HCV are unaware of their disease status. Measures to increase HCV screening are essential to diagnose early asymptomatic disease, before the onset chronic illness. A quality improvement study was conducted to increase provider awareness of and adherence to HCV screening recommendations. This resulted in an increase in HCV screening among asymptomatic individuals born between 1945 and 1965 (birth cohort 1945-1965). Although this study focused on birth cohort testing, implementation of similar initiatives may increase screening in larger populations.

Assessing the Effectiveness of Strategies in US Birth Cohort Screening for Hepatitis C Infection.

Chronic hepatitis C infection in the USA is a highly morbid condition and current guidelines recommend one-time screening among the birth cohort (1945-1965). Understanding strategies to optimize screening can help inform future hepatitis C virus (HCV) screening guidelines. A focused literature search was performed using PubMed and manual abstract review from major hepatology conferences over the past 2 years. The search strategy involved using Medical Subject Headings terms for hepatitis C, screening, birth cohort, baby boomers, and 1945-1965. The review was limited to data from the USA. A total of 327 articles were identified and 36 abstracts were included, with studies published between 2012-2019. Strategies including clinician education, electronic medical record alerts, reflex HCV RNA testing, point-of-care testing, multisite (outpatient, inpatient, emergency department, endoscopy suite) initiatives, direct patient solicitation, and utilization of non-physician providers have increased HCV screening rates. However, broad implementation remains less than optimal. Barriers include lack of patient acceptance to screening and engagement in the HCV care cascade. The Veterans Affairs Healthcare System has achieved higher birth cohort screening rates through an integrated approach requiring high-level engagement by leadership and institutional commitment. Multiple strategies for increasing birth cohort screening have been successful, but overall rates of HCV screening remain low. These strategies can inform public health efforts to implement emerging national recommendations for expansion of HCV screening to all U.S. adults age 18 or older.

291. Using Individualized Provider Feedback to Improve HCV Screening in a High-Volume Emergency Department

BackgroundEnding the Hepatitis C Virus (HCV) epidemic requires HCV testing as the critical first step. Busy urban Emergency Rooms are uniquely suited for HCV screening programs but numerous barriers to effective program implementation exist. We describe an emergency room physician champion model that utilizes the feedback intervention theory (FIT) to providers to increase HCV screening rates.MethodsDue to the changing epidemiology of HCV in 2017 New York Presbyterian supported one-time universal HCV screening. In September 2018, our physician champion provided an educational session to ED providers about the importance of HCV screening and the proposed study. From the end of September to the end of March 2019, providers received a monthly e-mail from the ED champion and an automated text message with their individual and peer HCV screening rates. The number of HCV tests and percent of individuals with documented HCV testing in the ED was compared pre and post this intervention and to HCV testing in the inpatient and outpatient setting where feedback was not provided.ResultsOn average ED providers evaluated approximately 14,000 patients per month. HCV testing increased 1,600% from an average of 40 tests per month in the 18 months prior to the intervention to an average of 640 tests sent per month during the intervention. tests sent in December. This was compared with stable inpatient and outpatient HCV screening during the same time period.ConclusionIndividualized provider feedback paired with an ED physician champion can lead to a significant increase in HCV testing. Ongoing studies will determine if this intervention can lead to long-term behavior change. Disclosures All authors: No reported disclosures.

Electronic medical record-verified hepatitis C virus screening in a large health system.

BackgroundBaby boomers are at increased risk for hepatitis C virus (HCV) infection and related cancer; therefore, one‐time HCV screening is recommended.MethodsTo assess prevalence of, and factors associated with providers ordering HCV screening, we examined a retrospective cohort of electronic medical records for patient visits from 01 August 2015 until 31 July 2017 in a large health system. HCV screening ordered was examined by patient age, gender, race/ethnicity, provider specialty, and number of clinical visits, stratified by birth cohort: born ≤1945, 1945‐1965 (baby boomers), 1966‐1985, and ≥1985. Multivariable regression identified factors independently associated with HCV screening ordered among average risk baby boomers.ResultsA total of 65 114 patients ages ≥18 years were evaluated. Among baby boomers HCV screening test order increased threefold between the two study years (4.0%‐12.9%). Odds of screening test ordered were significantly higher for non‐Hispanic Blacks (multivariable adjusted odds ratio [aOR]=1.36; 95% CI = 1.19‐1.55), males (aOR = 1.44; 95% CI = 1.33‐1.57), and having a clinic visit with a primary care provider alone or with specialty care (aOR = 3.25‐4.16). Medicare (aOR = 0.89; 95% CI = 0.80‐0.99), Medicaid (aOR 0.89; 95% CI 0.80‐0.99), and an unknown provider type (aOR = 0.16; 95% CI = 0.08‐0.33), were associated with lower odds of screening tests ordered.ConclusionsWhile the proportion of baby boomers with an HCV screening test ordered increased during the study, the rate of screening remains far below national goals. Data from this study indicate that providers are not ordering HCV screening universally for all of their baby boomer patients. Continued efforts to increase HCV screening are needed to reduce the incidence of HCV‐related morbidity and mortality.

Use of a Hepatitis C Screening Order Set to Improve Screening Rates and Measure Intervention Effectiveness.

Hepatitis C virus (HCV) infection leads to significant morbidity and mortality. Rates of HCV infection are greatest in patients born from 1945 to 1965, so the Centers for Disease Control recommends a one-time screening in this cohort. Previous interventions utilizing the electronic medical record (EMR) capabilities at two University of Utah Family Medicine clinics have increased screening rates significantly, but further improvement is possible. A family medicine resident-led continuous quality improvement (CQI) team used the Model for Improvement methods popularized by the Institute for Healthcare Improvement to create a team-based intervention with the goal of improving HCV screening in a family medicine faculty and resident clinic. An order set was created and a protocol developed that allowed medical assistants or clinic phlebotomists to order the appropriate HCV screening lab if this had not yet been done by the primary care provider. Data were extracted from the EMR that showed changes in total and monthly screening rates as well as the frequency of order set use. Monthly screening rates at the Madsen Family Medicine Clinic (Salt Lake City, UT) increased from approximately 40% to greater than 50% in the 5-month intervention period. The order set was used 19 times during this period which accounted for 18.8% of new screens. Creating an order set that allows medical assistants to order the HCV screening lab increased HCV screening rates in our clinic. Because order set utilization data can be extracted from the EMR, this intervention provided a process measure that can differentiate the effect of this intervention from the effects of other interventions previously undertaken in the clinic.

Aiming towards hepatitis C virus elimination in Greece.

There are estimated to be 74,000-134,000 patients living with chronic hepatitis C in Greece, but only 20-30% of them are aware of their disease status. In July 2017, the Hellenic National Plan for Hepatitis C was announced in alignment with the World Health Organization goals for the eradication of hepatitis C virus (HCV) by the year 2030. This article discusses the epidemiology and current treatment of chronic hepatitis C in Greece. Additionally the authors propose actions on how to bring back to care diagnosed patients lost to follow up, optimize access to care for HCV-infected people who inject drugs, and increase HCV screening in the general population. The medical community in Greece can play a pivotal role in the implementation of the HCV National Plan and in the efforts to reach the goal of HCV elimination.

Electronic Clinical Decision Support (eCDS) Intervention to Increase Hepatitis C Virus (HCV) Screening and Linkage to Care among Baby Boomers in Urban Safety-Net Health System

Objective: An estimated 3.5 million Americans are living with hepatitis C virus (HCV) infection and the majority is unaware of their infection. HCV causes significant morbidity and mortality and is one of the leading causes of hepatocellular carcinoma (HCC) and other liver complications. Baby boomers (born between 1945 and 1965) account for approximately 75% of people chronically infected with HCV. The CDC and USPSTF recommend universal one-time screening of all Baby Boomers. Methods: Cook County Health (CCH) implemented an electronic clinical decision support (eCDS) tool in September 2016 to increase HCV screening among baby boomers throughout its outpatient clinic network. We evaluated the impact of the eCDS tool on screening and the successive stages of the care continuum by analyzing the proportion of patients who completed 1) anti-HCV screening, 2) HCV RNA confirmatory testing, 3) HCV RNA detectable result, 4) liver staging, and 5) treatment in the 12-month periods pre- and post-implementation. Results: The number of baby boomers newly tested system-wide each month increased by 344% over the 24-month evaluation period. Of 15,630 patients tested for anti-HCV, 844 (5.4%) tested positive. Patients with anti-HCV positive results were predominantly male (59%), between the ages of 52 and 64 (70%), Black/African American (71%) and Non-Hispanic (86%). 605 (72%) of anti-HCV positive patients completed HCV ribonucleic acid (RNA) testing; of those patients, 347 (58%) had confirmed HCV infection. Of 347 patients with confirmed HCV infection, 198 completed liver staging and 68 initiated treatment. Conclusions: Implementation of eCDS tools across large urban safety-net health systems is an effective strategy for ensuring adherence to national guidelines for HCV screening among baby boomers. The high prevalence of HCV infection in this primarily male, Black/African American baby boomer population highlights the urgency of universal screening programs at similar institutions.

2213. Hepatitis C Virus (HCV) Care Continuum Post-implementation of Electronic Clinical Decision Support (eCDS) Tool to Increase HCV Screening Among Baby Boomers in Large Urban Health System

BackgroundAn estimated 3–4 million Americans are living with Hepatitis C virus (HCV) infection and more than half of these individuals are unaware of their HCV status. Baby Boomers (born between 1945 and 1965) are significantly more likely to have HCV infection and should be universally screened. In September 2016, Cook County Health and Hospital System (CCHHS) implemented an electronic clinical decision support (eCDS) tool to increase HCV screening and treatment among Baby Boomers (BB) in primary care sites.MethodsTo assess the impact of the eCDS tool on screening and the successive stages of the HCV care continuum, we analyzed the proportion of patients who completed (1) HCV antibody screening, (2) RNA confirmatory testing, (3) HCV RNA detectable result, (4) liver staging, (5) treatment initiation, and (6) treatment completion.ResultsBetween August 2015 and September 2017, the number of BB patients tested for HCV increased by 325% post-implementation of the eCDS tool. During this period, 17,585 BB patients were screened for HCV (3,349 pre-eCDS and 14,236 post-eCDS) and 822 unique patients were HCV antibody reactive (4.7% reactivity). Of 822 HCV antibody reactive patients, 583 (70.9%) completed HCV RNA confirmatory testing (70.0% pre-RNA reflex and 92.0% post-RNA reflex). Of 583 patients with HCV RNA confirmatory testing, 338 (58.0%) had detectable HCV RNA. Of 338 patients with detectable HCV RNA, 190 (56.2%) completed Fibroscan liver staging. Of 190 patients who completed liver staging, 65 (34.2%) patients completed treatment (Illinois Medicaid plans only cover HCV treatment for patients with F-3 and F-4 results). Of 65 patients who initiated treatment, 65 (100%) completed treatment. SVR data were not available for all patients. ConclusionThe HCV care continuum illustrates the stages at which barriers to accessing HCV medical care attenuate successful treatment of patients. The barriers and (mitigating solutions) are as follows: policy-level (e.g., insurance coverage), institutional-level (e.g., HCV RNA reflex testing), provider-level (e.g., EMR prompts), and patient-level (e.g., provision of support services).Disclosures All authors: No reported disclosures.

Improving Hepatitis C Screening Rates in a Resident Clinic: A Quality Improvement Project

Introduction: Hepatitis C virus (HCV) is the most common chronic blood-borne pathogen in the US. HCV is a viral liver disease that can result in cirrhosis, hepatocellular carcinoma, liver transplantation or death. CDC and USPSTF recommend HCV screening for all those born between 1945 and 1965- the baby boomer population. We designed a quality improvement project seeking to improve HCV screening rates in our ambulatory resident practice. Methods: We educated all residents and clinical staffs at ambulatory clinic by lectures, emails and weekly meetings about the importance of HCV screening in the baby boomers. All residents were asked to order a HCV Antibody profile as a screening test if the patient had never been tested. In case resident forgot to order it, then staff would order at the time of check out. If the test was positive, then patients were called and informed about the result and referred to hepatitis care clinic for further work up. Results: We screened 300 patients and 10 patients had a positive HCV screening test (3.3%). Only two patients had a positive viral load (20.0%). 5 out of 10 positive HCV positive patients had an intravenous drug abuse history (50.0%). No patient had undergone previous treatment for HCV infection. All 10 patients were referred to hepatitis care center for further monitoring. Conclusion: HCV screening is recommended in the baby boomer population (born between 1945-1965), history of illicit injection drug use or intranasal cocaine use and receipt of contaminated blood products or tissue. The initial screening test for chronic HCV infection in adults is an HCV antibody test. A reactive antibody test should be followed by a HCV RNA test. A nonreactive antibody test generally indicates the absence of chronic HCV infection. HCV screening can be increased by education and appropriate follow ups. Primary care clinics can successfully increase HCV screening in a relatively short time period. Incorporating a lecture about the new HCV screening guidelines to the ambulatory educational curriculum may be a more effective and sustainable strategy to increase HCV screening rates among residents.

Increased HCV Screening Yields Discordant Gains in Diagnoses Among Urban and Rural Veteran Populations in Texas: Results of a Statewide Quality Improvement Initiative

Chronic hepatitis C virus (HCV) infection is a significant health burden among military veterans. Our goals were to increase monthly HCV screenings, diagnoses, and sustained virologic responses (SVR) among 88,652 unscreened birth cohort Veterans in Texas. The interventions were enabled within six of the eight healthcare systems (HCSs) that compose Veteran's Integrated Service Network 17. The remaining two HCSs served as controls. The HCSs were separated into two groups: urban and rural; each composed of a control and three interventional HCSs. Decision support programming was embedded within the Computerized Patient Record System that prompted HCV screening among previously unscreened birth cohort patients. Clinical process design and educational efforts were enacted to enhance treatment capacity. Monthly screenings increased 4.89 times (p < 0.001) and 2.97 times (p < 0.001) during the postinterventional period relative to control for urban and rural HCSs, respectively. For urban HCSs, diagnoses increased 1.58 (p < 0.001) times more than the control group during the postinterventional period, but there was no difference in number of diagnoses in the rural HCSs (p = 0.86). Monthly SVR increased 2.69 times more than the control group during the postinterventional period (p < 0.001). Decision support improved HCV screening among birth cohort patients in both urban and rural HCSs. Increased screening boosted the monthly number of diagnoses in the urban HCSs, but not in the rural HCSs; which rebuts the utility of birth cohort screening among rurally residing veterans. These interventions significantly improved the rate of SVR achievement relative to control.

Hepatitis C Virus Screening Trends: Serial Cross-Sectional Analysis of the National Health Interview Survey Population, 2013-2015.

Background: Rates of hepatitis C virus (HCV) infection are markedly higher for baby boomers compared with other birth cohorts, and they are now recommended for universal one-time screening. This study examines HCV screening rates and predictors for four birth cohorts [born <1945, born 1945-1965 (baby boomers), born 1966-1985, and born >1985] of a nationally representative sample over time.Methods: We used data from the 2013-2015 National Health Interview Surveys, an annual weighted survey of the U.S. civilian noninstitutionalized population. We assessed HCV screening prevalence stratified birth cohort with bivariate and multivariable logistic regression analyses.Results: There were 15,100 participants born <1945, 28,725 baby boomers, 28,089 born 1966-1985, and 13,296 born >1985 in the final analytic sample. Screening was 11.5%-12.8% for baby boomers. The second youngest birth cohort was similar to baby boomers (13.7%-14.9%), whereas the older birth cohort was screened less. After excluding participants who typically have higher rates of HCV screening than the general population, we developed a multivariable model of the general population. In the final model for baby boomers the odds of HCV screening increased significantly with each subsequent year (OR=1.20; 95% CI=1.05-1.38 and OR=1.31; 95% CI=1.13-1.52). HCV screening was also significantly associated with age, gender, and race/ethnicity in baby boomers.Conclusions: While HCV screening is increasing over time, these increases are minimal and there is substantial room for improvement.Impact: Future research should develop interventions to increase HCV screening with special focus on groups demonstrating significantly lower screening rates, such as Hispanics and females. Cancer Epidemiol Biomarkers Prev; 27(4); 503-13. ©2018 AACR.