Hospital-Based Hepatitis C Screening of Baby Boomers in a Majority Hispanic South Texas Cohort: Successes and Barriers to Implementation

Abstract

Objective. To comply with the 2012 CDC recommendations for hepatitis C virus (HCV) screening, we implemented a new HCV screening program for patients born between 1945 and 1965 at a South Texas safety-net hospital.Methods. Patients with no HCV diagnosis or prior HCV test received an automated order for HCV antibody (anti-HCV) tests combined with reflex HCV ribonucleic acid (RNA) polymerase chain reaction. An inpatient counselor educated anti-HCV-positive patients. A bilingual patient navigator assisted newly diagnosed chronic HCV patients with linkage to primary and specialty care. We examined results for Hispanic vs. non-Hispanic patients in the first 10 months of project implementation in 2013-2014.Results. Of 2,327 patients screened for HCV, the 192 (8%) patients who tested anti-HCV positive were younger than those who tested negative (56 vs. 58 years, respectively, p,0.001) and more likely to be male (p,0.001). Of the 167 anti-HCV-positive patients tested for HCV RNA, 108 (65%) were HCV RNA positive (5% of cohort). Barriers to care for HCV RNA-positive patients included a lack of health insurance, current substance abuse, incarceration, and homelessness. Hispanic HCV RNA-positive patients were more likely than non-Hispanic HCV RNA-positive patients to be substance abusers or incarcerated. Of all HCV RNA-positive patients, 103 patients (95%) received counseling, 94 patients (87%) were linked to primary care, 47 patients (44%) were linked to specialty care, and eight patients (7%) started treatment.Conclusion. The prevalence of anti-HCV-positive and chronically HCV-infected patients was higher than many Hispanic or non-Hispanic white cohorts. Most Hispanic patients newly diagnosed with chronic HCV had barriers to care for HCV infection that must be overcome if HCV screening is to reduce morbidity and mortality in this population.

A systematic model improves hepatitis C virus birth cohort screening in hospital‐based primary care

“…There are interesting demographic differences in the patients that were screened and seropositive in our cohort. Although younger females were more likely to be screened for HCV during a primary care encounter, older males were more likely to be positive for HCV, consistent with prior studies. Patients that were insured in either practice were more likely to be screened, but there was no correlation with seropositive status.…”

Barriers to and facilitators of hepatitis C virus screening and testing: A scoping review

“…Most of the studies examined both health care provider and patient populations. Health care providers included general practitioners, clinical representatives from hospitals, newly qualified doctors, medical students, resident physicians and nurses (8)(9)(10)(11)(12)(13)(14). Patient groups included adults born between 1945 and 1965; patients attending sexually transmitted infections (STI) clinics, outpatient clinics or primary care facilities; youth and adults working in HIV/HCV prevention; immigrant and migrant populations; and sex workers (10,12,13,(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

“…Time constraints-more specifically, limited consultation times, competing priorities and lengthy pre-and post-test counselling procedures-were commonly cited barriers to HCV screening and testing (8,(10)(11)(12)(13). As a result, health care providers-especially general practitioners-did not routinely ask patients about HCV risk factors (8,21).…”

“…Limited interactions with the health care system, lack of a primary care provider and an unstable socioeconomic status were all identified in the literature as barriers to HCV testing reported by patients. Adults born between 1945 and 1965 have reported cost of testing, lack of health insurance, limited access to hepatology clinics and long wait times for appointments as barriers to HCV screening (13,19). Language barriers and lack of culturally sensitive health services limit migrant populations' access to HCV testing (20,22,23).…”

Les obstacles au dépistage du virus de l'hépatite C et les facteurs qui le facilitent : examen de la portée

“…Les contraintes de temps -plus spécifiquement, le temps de consultation limité, les priorités concurrentes et les longues procédures de soutien psychologique précédant et suivant le test de dépistage -étaient souvent citées comme des obstacles au dépistage du VHC (8,(10)(11)(12)(13). Il en résulte que les fournisseurs de soins de santé -particulièrement les médecins généralistesne posaient pas systématiquement à leurs patients de questions…”