Improved Hepatitis C Cure Cascade Outcomes Among Urban Baby Boomers in the Direct-Acting Antiviral Era

Abstract

Objectives: We compared outcomes of the hepatitis C virus (HCV) cure cascade (ie, the path a patient follows from diagnosis to cure), including antiviral treatment outcomes, from 2 HCV screening programs. Our objective was to assess whether treatment uptake and HCV cure rates improved in the cohort screened after the release of all-oral HCV direct-acting antiviral therapies. Methods: We retrospectively compared outcomes of the HCV cure cascade from a cohort of newly diagnosed patients screened during 2012-2014 (period 1) with outcomes from a cohort of newly diagnosed patients screened during 2015-2016 (period 2) at Grady Health System in Atlanta, Georgia. Cure cascade outcomes included HCV antibody (anti-HCV) and RNA testing, linkage to care, antiviral treatment, and sustained virologic response. Results: During period 1, 412 of 5274 (7.8%) persons screened were anti-HCV positive, and 264 (69.3%) of those tested were RNA positive. During period 2, 462 of 7137 (6.5%) persons screened were anti-HCV positive, and 240 (59.3%) of those tested were RNA positive ( P = .003). The percentage of newly diagnosed patients who were treated during period 2 (64.0%) was 3 times that of newly diagnosed patients treated during period 1 (21.2%; P < .001). Both cohorts had similarly high levels of linkage to care (95.8% during period 1, 95.4% during period 2) and cure (92.6% during period 1, 95.5% during period 2). Conclusions: Over time, the prevalence of anti-HCV and HCV RNA positivity declined substantially, and linkage-to-care and cure rates remained high. Treatment uptake increased significantly after the introduction of all-oral direct-acting antiviral therapy. These findings suggest that combining large-scale screening initiatives with treatment programs can speed progress toward HCV elimination.

Differences in inpatient and outpatient hepatitis C virus prevalence and linkage to care rates in a safety net hospital hepatitis C screening program

“…We found from years of outpatient testing that anti-HCV prevalence was highest at the beginning of the screening program, and decreased gradually over the course of 4 years. 20 This could be secondary to inadvertent bias by providers who may screen patients they deem at the highest risk first, despite guidance to screen all patients who meet criteria. Thus, we suspect that this represents a combined risk factor and birth cohort screening strategy (higher prevalence) than a pure birth cohort screening strategy (lower prevalence).…”

“…GHS is home to the Grady Liver Clinic (GLC), a primary care-based HCV specialty clinic that provides comprehensive HCV care and treatment and serves as a LTC venue. 20 We implemented sequential primary care-based HCV screening and LTC programs starting in 2012 and 2015. The programs utilized an EHR prompt to screen baby boomers and educational sessions for providers to promote HCV screening, as well as robust patient navigation to LTC.…”

“…The programs utilized an EHR prompt to screen baby boomers and educational sessions for providers to promote HCV screening, as well as robust patient navigation to LTC. 20 In February 2017, the screening program was expanded to the inpatient setting. The expansion involved modifying the standard inpatient admission order set to include a pre-checked anti-HCV test order.…”

“…[10][11][12][13][14][15][16][17][18] The use of best practice advisories in the electronic health record (EHR) to prompt screening has been successful. 9,19,20 Recent studies aimed at screening hospitalized patients highlighted the importance of confirmatory testing to identify those with current infection and underscored the need to focus on LTC of those individuals. [10][11][12][13][14][15][16][17][18][19]21 At Grady Health System (GHS), a safety-net health system in Atlanta, Georgia, we implemented sequential primary care-based HCV screening and LTC programs starting in 2012.…”

Large-Scale, Primary Care–Based Hepatitis C Treatment in an Urban, Medically Underserved Patient Population

“…These efforts from 2012 through 2019 resulted in the screening of more than 42 000 patients, the revealing of a ~6.5% prevalence of HCV exposure among outpatients screened and a 14% prevalence among inpatients screened, the identification of more than 1800 patients with chronic HCV infection, and linkage to care of more than 60% of eligible patients. 13,14 Treatment programs. For patients diagnosed with HCV, the GLC is the primary site for HCV care at GHS.…”