The continuum of hepatitis C testing and care

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• The hepatitis C virus (HCV) continuum of care (CoC) is essential for managing infected individuals.
• Many patients fail to progress through the HCV CoC, from screening to treatment.
• Previous studies on HCV CoC may lack generalizability.

Purpose of the Study:

• To assess the population-level HCV CoC in Philadelphia from 2010 to 2013.
• To identify stages where patients are lost in the HCV care pathway.
• To inform strategies for improving HCV management in urban settings.

Main Methods:

• Estimated HCV seroprevalence using national data and Philadelphia-specific demographics (homeless, incarcerated).
• Utilized reported HCV laboratory results and enhanced surveillance data for tracking patients.
• Defined the HCV CoC in four stages: screening, RNA testing, continuing care, and treatment.

Main Results:

• An estimated 47,207 (2.9%) of 1,584,848 Philadelphia residents had HCV.
• Of 13,596 positive HCV results, 6,383 (47%) had positive HCV-RNA tests.
• Only 1,745 (27%) of those with confirmed HCV RNA were in care, and 956 (15%) received treatment.

Conclusions:

• The study provides a real-world view of HCV disease management in a major U.S. city.
• Significant patient loss occurs at each stage of the HCV continuum of care.
• Increased awareness among healthcare professionals and at-risk populations is needed for hepatitis testing, referral, support, and care.