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Leave No-One Behind: A Retrospective Study of Hepatitis C Testing and Linkage to Care for Hospital Inpatients

Christine Roder1,2,3, Carl Cosgrave3, Kathryn Mackie3

  • 1Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia.

Viruses
|April 28, 2023
PubMed

Insights

Hospital admissions present a missed chance for hepatitis C virus (HCV) care. Many patients with HCV coding were not tested or treated, highlighting the need for improved hospital pathways to link individuals to essential hepatitis C treatment.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Public Health

Background:

  • Hospital admissions offer a critical, yet often missed, opportunity to connect patients with hepatitis C virus (HCV) to ongoing care and treatment.
  • Current hospital systems may not effectively identify or engage individuals with HCV, leading to gaps in the care cascade.

Purpose of the Study:

  • To determine the proportion of hospital inpatients and emergency department (ED) patients with hepatitis C who were linked to care and treatment.
  • To identify specific hospital departments and patient pathways that could be optimized for HCV engagement.

Main Methods:

  • Retrospective analysis of hospital databases (admissions, notifiable diseases, pharmacy) for adult patients with hepatitis C coding from March 2016 to March 2019.
  • Examination of documented antibody and RNA testing rates, and direct-acting antiviral (DAA) prescription data.
  • Comparison of HCV testing and linkage to care rates across different hospital departments.

Main Results:

  • Of 2149 patients with hepatitis C coding, only 15.4% had antibody tests, 4.6% had RNA tests, and 8.3% received DAA prescriptions.
  • Hepatitis specialist units showed high RNA testing rates (44.3%), while mental health had higher antibody testing (25.4%).
  • Emergency departments had low antibody testing (13.7%) but the highest RNA detection rate (46.9%) among those tested.

Conclusions:

  • Significant gaps exist in identifying and linking hospital patients with hepatitis C to care and treatment.
  • Simplified diagnostic pathways, expanded HCV services, and clear in-hospital referral systems are crucial for improving the care cascade.
  • Targeted interventions within hospital systems are necessary to scale up HCV testing and treatment for national elimination goals.

Keywords:
cascade of carehepatitis Clinkage to caretesting

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