Hepatitis C Screening of the “Birth Cohort” (Born 1945–1965) and Younger Inmates of New York City Jails

Akiyama, Matthew J.; Kaba, Fatos; Rosner, Zachary; Alper, Howard; Holzman, Robert S.; MacDonald, Ross

doi:10.2105/ajph.2016.303163

Cited by 22 publications

(19 citation statements)

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“…In our study, nearly 100% of birth cohort patients engaged in care were screened with antibody testing for HCV, a screening rate significantly higher than the 21-64% reported in other populations also engaged in care. [24][25][26] Differences in practice setting and their established screening protocols (e.g., jail, primary care clinics, integrated care systems), as well as the higher rates of HCV risk factors observed in the underserved that may translate into heightened awareness of HCV among patients and providers, [27][28][29] may have contributed to the wide range of reported screening rates. Interestingly, with the introduction of the birth cohort recommendations, we observed the greatest rise in HCV screening and treatment among APIs, which may be attributed to lower rates of traditional HCV risk factors observed in this population.…”

Section: Discussionmentioning

confidence: 99%

Race and Hepatitis C Care Continuum in an Underserved Birth Cohort

et al. 2018

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BACKGROUND: Birth cohort screening is recommended for hepatitis C virus (HCV) and underserved populations are disproportionally affected by HCV. Little is known about the influence of race on the HCV care continuum in this population. OBJECTIVE: To assess the cascade of HCV care in a large racially diverse and underserved birth cohort. DESIGN: Retrospective cohort study using electronic medical record data abstracted until August 31, 2017. PATIENTS: 34,810 patients born between 1945 and 1965 engaged in primary care between October 1, 2014, and October 31, 2016, within the safety-net clinics of the San Francisco Health Network. MAIN MEASURES: Rate of hepatitis C testing, hepatitis C treatment, and response to therapy. RESULTS: Cohort characteristics were as follows: median age 59 years, 57.6% male, 25.5% White (20.6% Black, 17.7% Latino, 33.0% Asian/Pacific Islander (API), 2% other), and 32.6% preferred a non-English language. 99.7% had an HCV test (95.4% HCV antibody, 4.3% HCVRNA alone). Among HCV antibody-positive patients (N = 4587), 22.9% were not tested for confirmatory HCVRNA. Among viremic patients (N = 3673), 20.8% initiated HCV therapy, 90.6% achieved sustained virologic response (SVR) and 8.1% did not have a SVR test. HCV screening and treatment were highest in APIs (98.7 and 34.7% respectively; p < 0.001). Blacks had the highest chronic HCV rate (22.2%; p < 0.001). Latinos had the lowest SVR rate (81.3%; p = 0.01). On multivariable analysis, API race (vs White, OR 1.20; p = 0.001), presence of HIV co-infection (OR 1.58; p = 0.02), presence of chronic kidney disease (OR 0.47; p < 0.001), English (vs non-English) as preferred language (OR 0.54; p = 0.002), ALT (OR 0.39 per doubling; p < 0.001), and HCVRNA (OR 0.83 per 10-fold increase; p < 0.001) were associated with HCV treatment. CONCLUSIONS: Despite near-universal screening, gaps in active HCV confirmation, treatment, and verification of cure were identified and influenced by race. Tailored interventions to engage and treat diverse and underserved populations with HCV infection are needed.

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Section: Discussionmentioning

confidence: 99%

Race and Hepatitis C Care Continuum in an Underserved Birth Cohort

et al. 2018

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“…More than two-thirds of those who reported IDU were HCV antibody positive, a rate that is similar to rates reported in noncorrectional settings. 19 Because low HCV-related case fatality rates and long-lasting serostatus result in a direct correlation between duration of IDU and HCV prevalence, 20 the observed age-related increase in HCV antibody positivity 17 may be a function of cumulative risk resulting from increased exposure to IDU over time. Nearly 60% of people with HCV infection in our study reported IDU: because fear of self-incrimination and lack of confidentiality may prevent inmates from reporting IDU, this percentage may underestimate the number of inmates who inject drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, although we found that HCV antibody prevalence was correlated overall with increasing age, a substantial number of HCV cases were identified among people who were born after 1965. 17 The objective of this study was to describe the correlates of HCV infection in the New York City jail population after the initiation of birth cohort screening. To date, the correlates of HCV infection in jail settings have been poorly characterized.…”

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confidence: 99%

Correlates of Hepatitis C Virus Infection in the Targeted Testing Program of the New York City Jail System

et al. 2016

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Objective: The objective of this study was to understand predictors of hepatitis C virus (HCV) antibody positivity in a large urban jail system in New York City. Methods:We examined demographic characteristics, risk behaviors, and HCV antibody prevalence among 10 790 jail inmates aged 16 to 86 who were screened from June 13, 2013, to June 13, 2014, based on birth cohort or conventional high-risk criteria. We used logistic regression analysis to determine predictors of HCV antibody positivity. Results: Of the 10 790 inmates screened, 2221 (20.6%) were HCV antibody positive. In the multivariate analysis, HCV antibody positivity was associated most strongly with injection drug use (IDU; adjusted odds ratio [aOR] ¼ 35.0; 95% confidence interval [CI], 28.5-43.0). Women were more likely than men to be infected with HCV (aOR ¼ 1.3; 95% CI, 1.1-1.5). Compared with non-Hispanic black people, Hispanic (aOR ¼ 2.1; 95% CI, 1.8-2.4) and non-Hispanic white (aOR ¼ 1.7; 95% CI, 1.5-2.1) people were more likely to be infected with HCV. Non-IDU, recidivism, HIV infection, homelessness, mental illness, and lower education level were all significantly associated with HCV infection. The prevalence rate of HCV infection among a subset of inmates born after 1965 who denied IDU and were not infected with HIV was 5.6% (198 of 3529). Predictors of HCV infection among this group included non-IDU as well as being non-Hispanic white, Hispanic, recidivist, and homeless.Conclusion: These data reveal differences in HCV infection by sex, race/ethnicity, and socioeconomics in a large jail population, suggesting that a focused public health intervention is required and that universal screening may be warranted. Further sensitivity and cost-benefit analyses are needed to make this determination.

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“…United States jails detain those awaiting trial or serving sentences of maximum 1-year duration. Among individuals tested in the New York City (NYC) jails during 2013–2014 using a risk factor-based and 1945–1965 birth cohort-based screening strategy, 21% were HCV antibody-positive [ 2 ]. Achieving national goals for HCV elimination [ 3 ] will require scaling up treatment for people who are incarcerated, including those in jail.…”

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confidence: 99%

Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care

Chan

Schwartz

Kaba

et al. 2020

Open Forum Infectious Diseases

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Background The population detained in the New York City (NYC) jail system bears a high burden of hepatitis C virus (HCV) infection. Challenges to scaling up treatment include short and unpredictable lengths of stay. We report on the clinical outcomes of direct-acting antiviral (DAA) treatment delivered by NYC Health + Hospitals / Correctional Health Services (CHS) in NYC jails from 2014-2017. Methods We performed a retrospective observational cohort study of HCV patients with detectable HCV RNA treated with DAA therapy while in NYC jails. Some patients initiated treatment in jail while others initiated treatment in the community and were later incarcerated. Our primary outcome was sustained virologic response at 12 weeks (SVR12). Results There were 269 patients included in our cohort, with 181 (67%) initiating treatment in jail and 88 (33%) continuing treatment started in the community. SVR12 virologic outcome data was available for 195 (72%) individuals. Of these, 172 (88%) achieved SVR12. Patients who completed treatment in jail were more likely to achieve SVR12 relative to those who were released on treatment (adjusted risk ratio 2.93, 95% CI 1.35, 6.34). Of those who achieved SVR12, 114 (66%) had a subsequent viral load checked. We detected recurrent viremia in 18 (16%) of these individuals, which corresponded to 10.6 cases per 100 person-years of follow-up. Conclusions HCV treatment with DAA therapy is effective in a jail environment. Future work should address challenges related to discharging patients while they are on treatment, loss to follow-up, and a high incidence of probable reinfection.

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Hepatitis C Screening of the “Birth Cohort” (Born 1945–1965) and Younger Inmates of New York City Jails

Abstract: Universal screening may be warranted pending further study including cost-effectiveness analyses.

Cited by 22 publications

References 5 publications

Race and Hepatitis C Care Continuum in an Underserved Birth Cohort

Race and Hepatitis C Care Continuum in an Underserved Birth Cohort

Correlates of Hepatitis C Virus Infection in the Targeted Testing Program of the New York City Jail System

Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care

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