Hepatitis C care cascade in a large academic healthcare system, 2012 to 2018

Area of Science:

• Hepatology
• Public Health
• Infectious Diseases

Background:

• The hepatitis C virus (HCV) care cascade remains a critical public health concern, particularly among the 1945-1965 birth cohort.
• Understanding the continuum of care is essential for developing targeted interventions to combat HCV.
• Electronic health records offer a valuable resource for analyzing patient care pathways.

Purpose of the Study:

• To evaluate the HCV care cascade within the 1945-1965 birth cohort receiving care at a large academic healthcare system.
• To identify gaps in screening, diagnosis, linkage to care, and treatment initiation for HCV.
• To assess the effectiveness of direct-acting antiviral (DAA) treatment in achieving sustained virologic response.

Main Methods:

• Retrospective analysis of deidentified electronic health records from January 2014 to June 2017.
• Identification of patients born between 1945-1965 who received outpatient care.
• Utilized laboratory data for HCV antibody, HCV RNA, and genotyping; DAA prescriptions indicated treatment initiation.

Main Results:

• Only 3% of the cohort (3,399/121,807) were screened for HCV, with a high seroprevalence of 16% (540/3,399) among those tested.
• Among 442 viremic patients, 54% were linked to care, 15% initiated DAA treatment, and 7% achieved sustained virologic response.
• Despite high HCV seroprevalence in the screened population, treatment initiation rates were low.

Conclusions:

• Significant gaps exist in HCV screening and linkage to care among the baby boomer cohort.
• Low rates of DAA treatment initiation highlight the need for improved access and adherence strategies.
• Enhanced screening protocols and streamlined care pathways are essential for achieving HCV elimination goals.