Hepatitis C Care Cascade in Opioid-Dependent Emergency Department Patients

Emergency departments (ED) have become important venues for hepatitis C (HCV) screening. Similarly, EDs have had increasing engagement in the management and treatment of opioid use disorder (OUD). Persons with OUD are at disproportionate risk for acquiring HCV. We sought to assess the intersection between OUD and HCV care through observing the uptake of HCV screening and subsequent steps in the HCV care cascade in an ED-OUD cohort.

This retrospective cohort study analyzed patients enrolled in an ED-OUD treatment program as a convenience sample subgroup of a larger institutional ED opt-out HCV screening program conducted at a single urban site in Alabama between July 2019-June 2022. Opt-out, nonfocused HCV screening provision was standardized at triage, excluding pregnant and incarcerated individuals. Descriptive analyses were conducted to ascertain screening uptake, positive screening, confirmatory testing, linkage to HCV treatment centers, and initiation of antiviral therapy. Additional patient level demographics considered included sex, race, age, insurance status, and domicile status.

Of the approximately 75,000 patients screened annually across the study timeframe, July 2019-June 2022, 359 patients with OUD were enrolled; enrolled participants were more likely to be male (64.9%), white (77.4%), aged 25 to 44 (73.3%), uninsured (80.5%) and housed (80.5%). Only 99 (27.6%) received an HCV antibody (Ab) screening test, 52 (52.5%) of which were positive. Thirty-three patients (63.5%) of the Ab-positive cohort were confirmed HCV viremic or 9.2% of the entire OUD cohort. Three (9.1%) of those with active viremia had documented post-ED HCV-specific care and only one was initiated on direct-acting antiviral therapy. White patients were more likely to be Ab-positive as compared to Black patients (88.5% vs 9.6%); however, Black patients were more likely to have active viremia (15.2%). Antibody-positive females had higher rates of viremia (80.0%) compared to Ab-positive males (53.1%).

Screening capture, subsequent RNA-positive linkage to care, and medication initiation rates were suboptimal, revealing opportunities for improvement across the care continuum. Incidence of active HCV viremia in the ED-OUD patient cohort is nine times higher than that in the general population and three times higher than that of the local general ED cohort.