Relationship Between Hepatitis C Clinical Testing Site and Linkage to Care

Assoumou, Sabrina A; Huang, Wei; Horsburgh, C. Robert; Drainoni, Mari-Lynn; Linas, Benjamin P.

doi:10.1093/ofid/ofu009

Cited by 17 publications

(20 citation statements)

References 10 publications

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“…Among a broad array of demographic and clinical factors included in our model, lack of insurance was the strongest independent predictor of LTC failure. These results are consistent with a recent report by Linas et al [7]. In their large, retrospective analysis, diagnosis in outpatient clinics, private insurance, and engagement in care (≥10 visits) were all independent predictors of successful LTC.…”

Section: Discussionsupporting

confidence: 92%

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Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

Franco

Overton

Tamhane

et al. 2016

Open Forum Infectious Diseases

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Background.Emergency departments (EDs) are high-yield sites for hepatitis C virus (HCV) screening, but data regarding linkage to care (LTC) determinants are limited.Methods.Between September 2013 and June 2014, 4371 baby boomers unaware of their HCV status presented to the University of Alabama at Birmingham ED and underwent opt-out screening. A linkage coordinator facilitated referrals for positive cases. Demographic data, International Classification of Diseases, Ninth Revision codes, and clinic visits were collected, and patients were (retrospectively) followed up until February 2015. Linkage to care was defined as an HCV clinic visit within the hospital system.Results.Overall, 332 baby boomers had reactive HCV antibody and detectable plasma ribonucleic acid. The mean age was 57.3 years (standard deviation = 4.8); 70% were male and 61% were African Americans. Substance abuse (37%) and psychiatric diagnoses (30%) were prevalent; 9% were identified with cirrhosis. During a median follow-up of 433 days (interquartile range, 354–500), 117 (35%) linked to care and 48% needed inpatient care. In multivariable analysis, the odds of LTC failure were significantly higher for white males (adjusted odds ratio [aOR], 2.57; 95% confidence interval [CI], 1.03–6.38) and uninsured individuals (aOR, 5.16; 95% CI, 1.43–18.63) and lower for patients with cirrhosis (aOR, 0.36; 95% CI, 0.14–0.92) and access to primary care (aOR, 0.20; 95% CI, 0.10–0.41).Conclusions.In this cohort of baby boomers with newly diagnosed HCV in the ED, only 1 in 3 were linked to HCV care. Although awareness of HCV diagnosis remains important, intensive strategies to improve LTC and access to curative therapy for diagnosed individuals are needed.

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Section: Discussionsupporting

confidence: 92%

“…The authors of this large retrospective analysis suggested that augmentation of ED testing would need to be reinforced by services to improve LTC. The study was limited by using HCV RNA testing as a proxy for LTC and inability to control for factors such as active injection drug use or mental illness [7]. …”

mentioning

confidence: 99%

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

Franco

Overton

Tamhane

et al. 2016

Open Forum Infectious Diseases

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“…Similar to our prior studies and those of others, we found a high HCV detection rate of 15%. 5,6 While most infected patients had not yet been treated by the end of the first year of sofosbuvir availability, it is encouraging that over 10% of known cases were treated within 12 months of sofosbuvir approval, especially when this treatment initiation rate is compared to the interferon era.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Until now, HCV treatment initiation and SVR have been rare events among urban patients. In a study including 293 HCV-infected patients at an urban Ohio county hospital, 28% (83) were treated and only 13% (11) of those treated achieved SVR.…”

mentioning

confidence: 99%

Real-world Outcomes of Hepatitis C Treatment during the Interferon-free Era at an Urban Safety-net Hospital

Assoumou¹,

Huang²,

Young³

et al. 2017

Journal of Health Care for the Poor and Underserved

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Background Little is known about real-world outcomes for new interferon-free treatment for hepatitis C virus (HCV) among underserved and diverse communities. Objective To identify predictors of treatment prescription and evaluate outcomes as measured by sustained virologic response (SVR) with HCV RNA testing three months after therapy completion. Design Retrospective cohort at a safety-net health care system. Participants Patients with (1) at least one clinical visit between December 6, 2013, and December 31st 2014; and (2) at least three months follow-up. Key results Predominantly non-White cohort (61%). Of 1,284 HCV-infected patients 121 prescribed sofosbuvir-based therapy. Severe liver fibrosis (OR 1.66, 95% CI 1.05, 2.64) independently associated with treatment prescription. In those with evaluable HCV RNA, SVR was 99%. Conclusion Cure rates similar to clinical trial data can be achieved in diverse underserved communities.

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“…Despite substantial gains in treating HCV with these new highly effective antiviral regimens, there are a number of barriers that prevent patients from receiving treatment. Of these, identification of HCV‐infected individuals and linking them to care have been the most challenging challenging . It is estimated that between 50% and 90% of HCV‐infected patients have been undiagnosed in the USA …”

Section: Introductionmentioning

confidence: 99%

The value of cure associated with treating treatment‐naïve chronic hepatitis C genotype 1: Are the new all‐oral regimens good value to society?

Younossi

Park

Dieterich

et al. 2016

Liver International

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Relationship Between Hepatitis C Clinical Testing Site and Linkage to Care

Abstract: When compared to those diagnosed in the outpatient, patients with reactive HCV testing in the Emergency Department or in the inpatient setting were less likely to link to care as measured by HCV RNA testing.

Cited by 17 publications

References 10 publications

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department

Real-world Outcomes of Hepatitis C Treatment during the Interferon-free Era at an Urban Safety-net Hospital

The value of cure associated with treating treatment‐naïve chronic hepatitis C genotype 1: Are the new all‐oral regimens good value to society?

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