Hepatitis C virus: Testing rate and attrition at linkage to specialized care, Catalonia, Spain 2011-2016

Hepatitis C virus (HCV) screening through primary care providers (PCP) might increase linkage to specialized care. This study aimed to calculate HCV testing rate and prevalence of anti-HCV according to socio-demographic factors in primary care in Catalonia, Spain, from 2011 to 2016, and to identify the rate and determinants of attrition at linkage to specialized care. Patient data from 274 primary care centres (3414 PCP) were analysed, including socio-demographic information, morbidity, laboratory tests and treatments (1-Jan-2011 to 31-Dec-2016). Both descriptive and inferential statistics were used to examine HCV testing rate, HCV seroprevalence and rate of attrition at linkage to specialized care. In the study period, there were 839 072 people tested for HCV infection and 21 156 with first-time positive anti-HCV test results. Rate of HCV testing was 143.54/10³ pop (95% CI: 143.26-143.83). Women had higher HCV testing rate (158.65/10³ women [95% CI: 158.24-159.07]), compared to men (128.10/10³ men [95% CI: 127.72-128.49]). The highest HCV testing rate was among people aged 25-34 (284.11/10³ pop [CIs: 283.10-285.12]). The anti-HCV seroprevalence was 3.62/10³ pop (CIs: 3.57-3.67). The highest prevalence was found among men (4.20/10³ men [CIs: 4.12-4.27]), people aged 45-54 (7.19/10³ pop [CIs: 7.01-7.37]), people aged 75-84 (7.26/10³ pop [CIs: 6.99-7.53]), Spanish (3.68/10³ [CIs: 3.61-3.75]), European and Northern Americans (5.64/10³ [CIs: 5.33-5.96]) and Asians (9.78/10³ [CIs: 9.21-10.35]). From those who had a positive anti-HCV result, 49.8% (N = 10 528) were not linked to specialized care. Appropriate clinical care pathways and referral systems need to be established to ensure optimal linkage to specialized care for people newly diagnosed with HCV in primary care.