High Hepatitis C Infection Rate among Baby Boomers in an Urban Primary Care Clinic: Results from the HepTLC Initiative

Geboy, Alexander; Mahajan, Sandeep; Daly, Allison P.; Sewell, C; Fleming, Ike C.; Hyun, Ah Kim; Perez, Idene E.; Cole, Carmella A.; Ayodele, Adebisi; Fishbein, Dawn

doi:10.1177/00333549161310s209

Cited by 19 publications

(22 citation statements)

References 12 publications

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“…A large number of the internal medicine clinic patients born between 1945 and 1965 declined screening for HCV, which is in contrast to previous studies that demonstrate the willingness of this population to be screened22 51 Furthermore, the HCV prevalence rate in the total internal medicine clinic patients born between 1945 and 1965 was 12.5% (162/1291), with a prevalence rate of 41.4% (162/391) in those that were screened. This rate is much higher than reported by other studies.…”

Section: Resultscontrasting

confidence: 68%

“…This rate is much higher than reported by other studies. For example, an HCV prevalence rate of 8.8% was reported in the screened birth cohort in an urban primary care clinic,51 and an HCV prevalence of 6.7% in screened individuals born between 1945 and 1965 was reported in a safety net hospital 22. The higher HCV prevalence in the internal medicine clinic patients born between 1945 and 1965 may be due to higher prevalence of substance use disorder in this population.…”

Section: Resultsmentioning

confidence: 98%

“…Furthermore, the internal medicine clinic population consists largely of African-American (66.8%). HCV has been shown to disproportionately affect African-Americans 41 51…”

Section: Resultsmentioning

confidence: 99%

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Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

et al. 2019

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Individuals born between 1945–1965 represent 81% of all persons chronically infected with hepatitis C virus (HCV) in the USA and are largely unaware of their positive status. The baseline HCV screening rate in this population in an academic internal medicine clinic at a US hospital was less than 3.0%. The goal was to increase the rate of HCV screening in patients born between 1945 and 1965 to 20% within 24 months. The quality improvement team used the Plan Do Study Act Model. Outcome measures included HCV antibody screening, HCV RNA positive rate and linkage to hepatology care. Process measures included HCV antibody order and completion rates. The quality improvement team performed a root cause analysis and identified barriers for HCV screening and linkage to care. The key elements of interventions included redesigning nursing workflow, use of health information technology and educating patients, physicians and nursing staff about HCV. The HCV screening rate was 30.3% (391/1291) within 24 months. The HCV antibody positive rate was 43.5% (170/391), and HCV RNA positive rate was 95.3% (162/170). HCV infection was diagnosed in 12.5% (162/1291) of patients or 41.4% (162/391) of the screened population. Of those positive, 70% (114/162) were linked to hepatology care within the 24-month project timeframe. Eighty percent of patients seen by a hepatologist were treated with direct-acting antivirals agents. The HCV screening rate was sustained at 25.4% during the post-project 1-year period. Engagement of a multidisciplinary team and education to patients, physicians and nursing staff were the key drivers for success.

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Section: Resultscontrasting

confidence: 68%

Section: Resultsmentioning

confidence: 98%

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Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

et al. 2019

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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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“…These recommendations alleviate the discomfort reported by clinicians in eliciting HCV risk factors and may increase HCV testing and case detection rates [6]. When fully integrated into primary care, routine “birth cohort” based HCV testing is expected to lead to identification of previously undiagnosed persons with HCV infection [7,8]. …”

Section: Introductionmentioning

confidence: 99%

Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era

Falade‐Nwulia¹,

McAdams-Mahmoud²,

Irvin³

et al. 2016

J Community Med Health Educ

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BackgroundThere are over 3 million Americans infected with hepatitis C virus (HCV). Despite recent advances in HCV treatment, a major barrier to care remains a limited number of treaters. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians.ObjectiveTo characterize current HCV care practices, willingness and self-efficacy of PCPs to become HCV treaters.Design, participants and main measuresTwo hundred and seventy one PCPs were identified from community clinics affiliated with a large academic center and 4 large federally qualified health centers in Baltimore, MD. An internet-based survey was administered to assess provider demographics, clinical practice site and willingness to provide HCV care. Factors associated with willingness to provide HCV care were examined using odds ratios (OR).Key resultsAmong 129 (48%) PCPs who responded, the majority (70%) had an MD/DO degree and were white (60%). Only a few PCPs, 12 (10%), had treated at least 1 patient for HCV in the prior year. Although only 22% agreed that HCV treatment should be provided by PCPs, 84% were interested in more HCV training. Willingness to provide treatment was strongly linked to having a high proportion of HCV-infected patients (>20% versus <20%; OR 3.9; 95% confidence interval [CI] 1.5–10) and availability of other services at the primary care site including HIV treatment (OR 6.5; 95% CI 2.5–16.5), substance abuse treatment (OR 3.3; 95% CI 1.3–8.4) and mental health services (OR 4.9; 95% CI 2.0–12.1).ConclusionThese data suggest that efforts to expand HCV medical provider capacity will be most impactful if they initially focus HCV training on PCPs with a high prevalence of HCV among their patients and existing systems to support HCV care.

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High Hepatitis C Infection Rate among Baby Boomers in an Urban Primary Care Clinic: Results from the HepTLC Initiative

Cited by 19 publications

References 12 publications

Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

Race and Hepatitis C Care Continuum in an Underserved Birth Cohort

Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era

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