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Outcomes of a Hepatitis C screening program at a large urban VA medical center
Holly Groom1, Eric Dieperink, David B Nelson
1Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Insights
Implementing Hepatitis C (HCV) screening guidelines led to 73% of patients attending a specialty clinic, with 24% receiving antiviral therapy. Further improvements in referral and treatment engagement are necessary for better HCV outcomes.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Limited data exists on the real-world outcomes of institutional Hepatitis C screening programs.
- Understanding the effectiveness of clinical guidelines is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the outcomes of clinical care guidelines for Hepatitis C (HCV) screening, evaluation, and treatment.
- To assess the effectiveness of an implemented HCV care pathway in a large urban Veterans Affairs Medical Center.
Main Methods:
- Retrospective review of patients tested for Hepatitis C from January 2000 to December 2001.
- Logistic regression analysis to identify factors associated with successful referral and treatment.
Main Results:
- Over 36,000 patients were screened, with 5.4% testing positive for HCV antibodies and 4.2% being HCV-RNA-positive.
- Of those RNA-positive, 83% were referred, 73% attended a Hepatitis C clinic, and 44.6% underwent liver biopsy.
- Antiviral therapy was given to 24% of the viremic cohort, with sustained virologic response in 37% of treated patients.
Conclusions:
- The implemented screening and referral program successfully engaged a majority of HCV-RNA-positive patients in specialty care.
- A significant proportion (24%) of patients likely to benefit received antiviral therapy, but further interventions are needed to increase treatment rates.
- Improvements in referral, care engagement, and antiviral treatment are essential to enhance outcomes for patients with Hepatitis C.
Goals:
To determine the outcomes of implementing clinical care guidelines for Hepatitis C screening, evaluation, and treatment in a large urban Veterans Affairs Medical Center.
Background:
Little information exists regarding the actual outcomes of institutional screening programs for Hepatitis C.
Study:
Retrospective review of all patients tested for Hepatitis C at the Minneapolis Veterans Affairs Medical Center from January 1, 2000 to December 31, 2001. Logistic regression was used to determine factors related to successful referral and treatment.
Results:
During this period 36,422 unique patients were screened for Hepatitis C virus (HCV) risk factors, resulting in 12,485 HCV enzyme-linked immunoassay antibody tests. HCV antibodies were positive in 681 (5.4%) patients and 520 (4.2%) were HCV-RNA-positive. Of HCV-RNA-positive patients, 430 (83%) were referred, 382 (73%) attended the Hepatitis clinic, and 232 (44.6%) received liver biopsies. Patients referred had significantly fewer comorbidities, known marital status, and greater prior clinic attendance than those not referred. Overall, 124 patients with established fibrosis received antiviral therapy (32% of patients attending clinic or 24% of viremic cohort). White race, fewer major medical problems, and age less than 60 years predicted antiviral treatment. Sustained virologic response occurred in 46 (37%) of treated patients (9% of the viremic cohort). Patients with a sustained virologic response include 17 patients with stage 3 to 4 fibrosis.
Conclusions:
This screening and referral program resulted in 73% of HCV-RNA-positive patients attending a specialty Hepatitis C clinic and 24% of those most likely to benefit received antiviral therapy. Measures to increase referral, engagement in care, and antiviral treatment are needed.
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