Relationship between hepatitis C clinical testing site and linkage to care

Area of Science:

• Hepatology
• Public Health
• Infectious Diseases

Background:

• The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) screening for individuals born between 1945-1965.
• Follow-up HCV RNA testing is advised for those with reactive serology.
• Expanding testing beyond outpatient clinics (OC) to inpatient wards (IP) or emergency departments (ED) may enhance diagnosis rates.

Purpose of the Study:

• To determine factors associated with linkage to HCV care, defined by HCV RNA testing.
• To evaluate the rate of linkage to care based on the location of HCV diagnosis (OC, IP, or ED).

Main Methods:

• Retrospective cohort study using electronic medical records from 2005-2010 at an urban safety net hospital.
• Inclusion criteria: patients with reactive HCV serology.
• Multivariable regression modeling to identify factors associated with HCV RNA testing.

Main Results:

• Of 37,828 individuals tested, 5,885 (16%) had reactive HCV serology.
• Among 4,466 eligible patients, 76% were diagnosed in OC, 22% in IP, and 2% in ED.
• 48% of eligible patients underwent HCV RNA testing.
• Diagnosis in OC (OR, 1.64), private insurance (OR, 1.17), and ≥10 visits post-diagnosis (OR, 2.15) were associated with higher odds of RNA testing. Older age was associated with lower odds (OR, 0.98).

Conclusions:

• Testing for hepatitis C virus (HCV) in settings beyond traditional outpatient clinics presents an opportunity to increase diagnoses.
• Effective linkage to care initiatives are crucial to maximize the benefits of expanded HCV testing sites.