Results of Hepatitis C Birth-Cohort Testing and Linkage to Care in Selected U.S. Sites, 2012-2014
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Rajiv C Patel1, Claudia Vellozzi2, Bryce D Smith3
1Oak Ridge Institute for Science and Education, Oak Ridge, TN.
Insights
Hepatitis C virus (HCV) birth-cohort testing successfully identified infections in 11.6% of individuals born 1945-1965. Strategies are needed to improve linkage to care for those diagnosed with HCV.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Hepatology
Background:
- The U.S. Centers for Disease Control and Prevention (CDC) recommended one-time hepatitis C virus (HCV) testing for individuals born between 1945 and 1965.
- The Hepatitis Testing and Linkage to Care (HepTLC) initiative was launched to implement this birth-cohort testing strategy in U.S. healthcare settings.
Purpose of the Study:
- To describe the demographic characteristics, HCV infection prevalence, and associated risk factors among the baby boomer generation tested.
- To evaluate the effectiveness of the HepTLC initiative in identifying HCV infections within this key demographic.
Main Methods:
- The HepTLC initiative involved 14 grantees and 104 healthcare sites across 21 U.S. municipalities.
- Participants born between 1945-1965 were tested for HCV antibody (anti-HCV).
- Outcomes along the HCV testing-to-care continuum were assessed, including anti-HCV positivity, HCV RNA testing, HCV RNA positivity, referral to care, and appointment attendance.
Main Results:
- A total of 24,966 individuals were tested, with an 11.6% anti-HCV positivity rate (2,900 individuals).
- Highest anti-HCV positivity was observed in non-Hispanic black individuals (13.9%), men (17.1%), and those born between 1951-1955 (13.8%).
- Among those positive for anti-HCV, 72.7% received an HCV RNA test, 51.6% were HCV RNA positive, 41.4% were referred to care, and 32.3% attended their first medical appointment.
Conclusions:
- Birth-cohort HCV testing among individuals born between 1945 and 1965 is effective in identifying infections without needing to solicit specific risk factors.
- Further development and evaluation of strategies are crucial to enhance patient outcomes throughout the HCV testing-to-care continuum.
Objective:
Following its recommendation for one-time hepatitis C virus (HCV) testing of people born between 1945 and 1965, CDC implemented the Hepatitis Testing and Linkage to Care (HepTLC) initiative to conduct birth-cohort hepatitis testing in U.S. health-care settings. We describe demographic characteristics, HCV infection prevalence, and HCV-related risk factors among people born between 1945 and 1965 who were tested as part of the program, which ran from 2012 to 2014.
Methods:
As part of the HepTLC initiative, 14 grantees supporting 104 health-care sites in 21 U.S. municipalities tested participants born between 1945 and 1965 for HCV antibody (anti-HCV). Demographic characteristics and HCV risk factors were reported for people tested for anti-HCV and who were anti-HCV or HCV RNA positive. We evaluated outcomes along the HCV testing-to-care continuum using the following indicators: anti-HCV positive, HCV RNA test offered, HCV RNA positive, referred to care, and attended first medical appointment.
Results:
Among 24,966 people tested for HCV infection, 2,900 (11.6%) were anti-HCV positive. Anti-HCV positivity was highest among those who self-identified as non-Hispanic black (n=1,701 of 12,202, 13.9%), men (n=2,073 of 12,130, 17.1%), and people born between 1951 and 1955 (n=795 of 5,768, 13.8%). Of the 2,900 people testing anti-HCV positive, 2,108 (72.7%) received an HCV RNA test, 1,497 (51.6%) were HCV RNA positive, 1,201 (41.4%) were referred to care, and 938 (32.3%) attended their first appointment.
Conclusion:
Testing for HCV infection among those born between 1945 and 1965 without soliciting HCV risk factors was successful. Providers implementing birth-cohort testing should develop and evaluate strategies to improve outcomes along the testing-to-care continuum.
