Hepatitis C Among High-Risk Alabamians: Disease Burden and Screening Effectiveness

Abstract Background The effectiveness of hepatitis C testing and linkage-to-care (LTC) is poorly characterized in low-resource jurisdictions facing gaps in harm reduction, including illegality of syringe exchange services. Effectiveness of a community-based test/LTC program was evaluated in Alabama. Methods In 2016–2018, shelters, drug treatment centers (DTCs), AIDS organizations, and Federally Qualified Health Centers (FQHCs) engaged in screening/LTC. A coordinator navigated individuals to confirm viremia and link to substance use treatment or primary care with hepatitis C prescribers. Results Point-of-care (POC) tested 4293 individuals (10% [427] antibody-positive, 71% [299/419] RNA performed, 80% [241/299] viremia confirmed) and 93% linked to care (225/241). Electronic medical record (EMR)-based reflex strategy screened 4654 (15% [679] antibody positive, 99% [670/679] RNA performed, 64% [433/679] viremia confirmed) and 85% linked to care (368/433). We observed higher odds of RNA confirmation in EMR-based reflex versus POC (OR, 2.07; P < .0001) and higher odds of LTC in EMR-based reflex versus POC (OR, 1.51; P < .0001). Overall, 53% individuals tested were nonbaby boomers. Conclusions In Alabama, screening at high-risk settings identified significant hepatitis C burden and reflex testing outperformed point-of-care linkage indicators. Colocating testing in DTCs and treatment in FQHCs provided key LTC venues to at-risk younger groups.

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Pharmacy-based molecular point-of-care testing for hepatitis C (HCV) in high-risk patients: feasibility and linkage to care

Journal of Hepatology ◽

10.1016/s0168-8278(20)31116-8 ◽

2020 ◽

Vol 73 ◽

pp. S307

Author(s):

Benedict Rogers ◽

James Spear ◽

Vinay Mistry ◽

Martin Wiselka ◽

Manish Pareek

Keyword(s):

Hepatitis C ◽

High Risk ◽

Point Of Care ◽

Linkage To Care ◽

Point Of Care Testing ◽

High Risk Patients ◽

Risk Patients

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Hepatitis C Diagnosis: Simplified Solutions, Predictive Barriers, and Future Promises

Diagnostics ◽

10.3390/diagnostics11071253 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1253

Author(s):

Imran Shahid ◽

Abdullah R. Alzahrani ◽

Saeed S. Al-Ghamdi ◽

Ibrahim M. Alanazi ◽

Sidra Rehman ◽

...

Keyword(s):

Hepatitis C ◽

Point Of Care ◽

Public Health Care ◽

Clinical Experiences ◽

Middle Income ◽

Middle Income Countries ◽

Care Plans ◽

Care Cascade ◽

Reflex Testing ◽

Developed Nations

The simplification of current hepatitis C diagnostic algorithms and the emergence of digital diagnostic devices will be very crucial to achieving the WHO’s set goals of hepatitis C diagnosis (i.e., 90%) by 2030. From the last decade, hepatitis C diagnosis has been revolutionized by the advent and approval of state-of-the-art HCV diagnostic platforms which have been efficiently implemented in high-risk HCV populations in developed nations as well as in some low-to-middle income countries (LMICs) to identify millions of undiagnosed hepatitis C-infected individuals. Point-of-care (POC) rapid diagnostic tests (RDTs; POC-RDTs), RNA reflex testing, hepatitis C self-test assays, and dried blood spot (DBS) sample analysis have been proven their diagnostic worth in real-world clinical experiences both at centralized and decentralized diagnostic settings, in mass hepatitis C screening campaigns, and hard-to-reach aboriginal hepatitis C populations in remote areas. The present review article overviews the significance of current and emerging hepatitis C diagnostic packages to subvert the public health care burden of this ‘silent epidemic’ worldwide. We also highlight the challenges that remain to be met about the affordability, accessibility, and health system-related barriers to overcome while modulating the hepatitis C care cascade to adopt a ‘test and treat’ strategy for every hepatitis C-affected individual. We also elaborate some key measures and strategies in terms of policy and progress to be part of hepatitis C care plans to effectively link diagnosis to care cascade for rapid treatment uptake and, consequently, hepatitis C cure.

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Outcomes of hepatitis C testing, linkage to care, and treatment in a community based program in high versus low prevalence sites

Journal of Hepatology ◽

10.1016/s0168-8278(18)30530-0 ◽

2018 ◽

Vol 68 ◽

pp. S159

Author(s):

L. Magaldi ◽

N. Brown ◽

C. Coleman ◽

M. Dorshimer ◽

J. Kostman ◽

...

Keyword(s):

Hepatitis C ◽

Linkage To Care ◽

Community Based ◽

Care And Treatment ◽

Low Prevalence

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The effect of introducing point-of-care or dried blood spot analysis on the uptake of hepatitis C virus testing in high-risk populations: A systematic review of the literature

International Journal of Drug Policy ◽

10.1016/j.drugpo.2015.05.001 ◽

2015 ◽

Vol 26 (11) ◽

pp. 1050-1055 ◽

Cited By ~ 54

Author(s):

Josh T. Coats ◽

John F. Dillon

Keyword(s):

Systematic Review ◽

Hepatitis C Virus ◽

Hepatitis C ◽

High Risk ◽

Point Of Care ◽

Review Of The Literature ◽

High Risk Populations ◽

Virus Testing ◽

Blood Spot ◽

Spot Analysis

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DIFERENCIAS EN EL ACCESO Y EN EL TIEMPO HASTA EL INICIO DE TRATAMIENTO HEPATITIS C EN PERSONAS CON DESORDENES DE SALUD MENTAL

10.17579/sepd2021o048 ◽

2021 ◽

Keyword(s):

Hepatitis C ◽

Point Of Care ◽

Linkage To Care ◽

Mental Health Disorder ◽

Additive Models ◽

Unique Challenge ◽

Direct Acting Antiviral ◽

Salud Mental ◽

Vulnerable Subpopulations ◽

Direct Acting

People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analyzed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point of care. to identify gaps and barriers to improve HCV elimination efforts in these populations. Methods: From 2019 to 2021, a mobile unit was used to screen for HCV using a linkage-to-care and two-step point-of-care-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals, people with a mental health disorder (MHD) and people with alcohol use disorder (AUD). Logistic regression and Cox and Aalen’s additive models were used to analyze associated factors and differences between groups. Results: A prospectively recruited cohort of 214 HCV infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that: 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved a sustained virological response (SVR). PWID were significantly less likely to initiate treatment, while individuals with AUD waited longer before starting treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment. Conclusions: Overall, SVR was achieved in the majority of the participants treated. However, PWID need better linkage to care and treatment, while PWID and AUD need more support for treatment completion.

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Hepatitis C testing and linkage to care among adults on probation in a large US city

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab636 ◽

2021 ◽

Author(s):

Kevin F Kamis ◽

David L Wyles ◽

Matthew S Minturn ◽

Tracy Scott ◽

Dean McEwen ◽

...

Keyword(s):

Hepatitis C ◽

Point Of Care ◽

Linkage To Care ◽

Virologic Response ◽

Patient Navigator ◽

Hcv Rna ◽

Study Cohort ◽

Hcv Treatment ◽

Hiv Test ◽

Hcv Testing

Abstract Background Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We implemented an HCV testing and patient navigation program at an adult probation department. Methods Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a lab-based HCV RNA assay if anti-HCV positive. All individuals received counseling rooted in harm-reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless lost to follow-up. Study participation involved an optional survey and optional point-of-care HIV test. Results Of 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34/52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. 193 individuals tested for HIV; none tested positive. Conclusions The study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage-to-care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage-to-care could improve health in this population. Co-localization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.

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Addressing the disease burden of vertically-acquired hepatitis C virus (HCV) infection among opioid-exposed infants

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz448 ◽

2019 ◽

Author(s):

Stella Protopapas ◽

Liza Bronner Murrison ◽

Scott L Wexelblatt ◽

Jason T Blackard ◽

Eric S Hall

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

High Risk ◽

Disease Burden ◽

Hcv Infection ◽

Control Analysis ◽

Factors Associated ◽

High Risk Infants ◽

Urine Testing ◽

Hcv Testing

Abstract Purpose This study aims to estimate the disease burden of vertically-acquired hepatitis C virus (HCV) in a large Midwestern hospital; and to identify factors associated with HCV diagnostic testing among high-risk infants. Methods Retrospective analysis of an infant cohort (n=58,427) born from 2014-2016 in the Greater Cincinnati region, where universal maternal urine testing is conducted at delivery to assess for intrauterine drug exposure (IUDE). Demographics and birth characteristics were analyzed among high-risk infants to identify factors associated with receiving HCV testing. A nested matched case-control analysis examined the association of pediatric HCV infection and IUDE. Results The HCV prevalence rate among high-risk infants who received testing was 3.6-5.2% of births. Approximately 66.7% of maternally-acquired HCV infections may be missed using current testing recommendations. Prenatal care had no significant effect (aOR 1.2 [95%CI 0.4-3.5]) on the odds of a high-risk infant receiving HCV testing. Opioid-exposed cases had an over 6-fold increase in the odds of HCV infection (aOR 6.2 [95%CI 2.3-16.6]) compared to non-opioid exposed infants. Conclusions IUDE was significantly associated with increased odds of pediatric HCV infection in this population. The gaps in pediatric HCV testing identified in this study, despite known risk level and maternal infection, suggest the need for increased focus on HCV identification in the pediatric population.

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