Hepatitis C identification and treatment in rural Pennsylvania, USA

Abstract

The opioid epidemic in the United States has led to increases in hepatitis C virus (HCV) infection especially in rural communities. It is recommended that persons who inject drugs undergo screening and treatment. We initiated HCV screening and treatment within a mostly rural area of Pennsylvania by targeting medicated-assisted treatment (MAT) facilities and community events. Screening was conducted in 43 rural and 13 urban counties by a clinical team. At MAT facilities, the clinical team performed HCV screening between 4:30 am and 1:00 pm using the OraQuick HCV test free of charge. Participants with a positive screen were linked to treatment. In all, 3,051 screening tests were conducted among 2,995 unique participants, who were mostly white (2821, 94%) and from rural counties (2597, 87%). Participants were most frequently 25-to-34 years old (798, 27%). A total of 730 patients were HCV screen positive, 371 patients received an HCV RNA PCR test, and 272 were HCV RNA positive. Of them, 249 met with a healthcare provider, 102 initiated treatment, and 50 completed SVR testing, with 49 achieving SVR. Anti-HCV positivity was more frequent among MAT facility versus non-MAT patients (41% versus 5%) ( p < .001). Non-MAT participants were more likely to begin treatment for HCV (91% [21/23] versus 30% [81/272]) and achieve SVR (71% versus 43%). In HCV screening and treatment among high-risk patients, substantial numbers of participants were lost at every point of care between screening and follow-up testing. Specific screening, treatment, and follow-up strategies for persons in rural communities may be needed.

Hepatitis C Virus Cascade of Care Among Perinatal Patients in Maine Diagnosed With Opioid Use Disorder, 2015–2020

“…Recent recommendations to incorporate treatment into primary care and nonspecialist environments, or through the use of telemedicine, have proven both safe and effective, making DAA treatment much more readily available. 21,33,34 Although Maine's Medicaid program covered DAA treatment throughout the entire study period, it updated its pharmacy benefit in 2021 and made it simpler for a larger number of clinicians, not only infectious disease or gastroenterology specialists, to treat uncomplicated HCV. 35,36 Previously, the DAA prior authorization required the review of an infectious disease or gastroenterology specialist before it would be approved.…”

Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis

“…Point-of-care and dried blood spot (DBS) testing technologies for hepatitis B and C present opportunities to simplify testing processes, increase case detection, and facilitate linkage to treatment in community settings, particularly low resource settings. 8 , 9 Hepatitis B and C point-of-care testing programs have already shown meaningful public health benefit across various community settings including community outreach, 10 , 11 , 12 , 13 harm reduction and addiction centres, 14 , 15 , 16 and health-facility settings. 17 , 18 , 19 Pharmacies present another potential community setting to employ point-of-care testing programs and establish pathways to treatment with local prescribers or in pharmacies themselves.…”