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

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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The Copenhagen test and treat hepatitis C in a mobile clinic study: a protocol for an intervention study to enhance the HCV cascade of care for people who inject drugs (T’N’T HepC)

BMJ Open ◽

10.1136/bmjopen-2020-039724 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039724

Author(s):

Jeffrey Victor Lazarus ◽

Anne Øvrehus ◽

Jonas Demant ◽

Louise Krohn-Dehli ◽

Nina Weis

Keyword(s):

Hepatitis C ◽

People Who Inject Drugs ◽

Intervention Study ◽

Point Of Care ◽

Linkage To Care ◽

Antibody Test ◽

Hcv Rna ◽

Mobile Clinic ◽

Primary Driver ◽

Hcv Testing

IntroductionInjecting drug use is the primary driver of hepatitis C virus (HCV) infection in Europe. Despite the need for more engagement with care, people who inject drugs (PWID) are hard to reach with HCV testing and treatment. We initiated a study to evaluate the efficacy for testing and linkage to care among PWID consulting peer-based testing at a mobile clinic in Copenhagen, Denmark.Methods and analysisIn this intervention study, we will recruit participants at a single community-based, peer-run mobile clinic. In a single visit, we will first offer participants a point-of-care HCV antibody test, and if they test positive, then they will receive an HCV RNA test. If they are HCV-RNA+, we will administer facilitated referrals to designated ‘fast-track’ clinics at a hospital or an addiction centre for treatment. The primary outcomes for this study are the number of tested and treated individuals. Secondary outcomes include individuals lost at each step in the care cascade.Ethics and disseminationThe results of this study could provide a model for targeting PWID for HCV testing and treatment in Demark and other settings, which could help achieve WHO HCV elimination targets. The Health Research Ethics Committee of Denmark and the Danish Data Protection Agency confirmed (December 2018/January 2019) that this study did not require their approval. Study findings will be disseminated through peer-reviewed publications, conference presentations and social media.

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313. Bringing Hepatitis C into FOCUS: Evaluating the Efficiency of a Linkage to Care Program in Improving the Hepatitis C Care Cascade

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.386 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S166-S166

Author(s):

Brittany M Battle ◽

Michael Gierlach ◽

Brian Allen ◽

Melissa O Jenkins ◽

Ann Avery

Keyword(s):

Hepatitis C ◽

Linkage To Care ◽

Specialty Care ◽

Diagnosis And Treatment ◽

Hcv Rna ◽

Newly Diagnosed ◽

Hcv Treatment ◽

Start Date ◽

Treatment Start ◽

Significant Difference

Abstract Background In 2016, The MetroHealth System began enhanced hepatitis C (HCV) screening through decision support, coupled with linkage of newly diagnosed patients to specialty care by a Linkage to Care coordinator (LTCC). Prior to this, patients were notified of their HCV diagnosis by a provider and given a referral to a specialist. We hypothesized that an LTCC would shorten time from HCV diagnosis to HCV treatment. Methods Patients newly diagnosed with HCV between June 1, 2015 and December 31, 2015 (Pre-LTCC), were compared with patients newly diagnosed between January 1, 2016 and March 31, 2017 (Post-LTCC). Patients who were HCV RNA negative were excluded. The time between diagnosis and linkage, linkage and treatment start date, and diagnosis and treatment start date for each population were compared using unpaired t-tests. Results 125 newly diagnosed patients were identified in the Pre-LTCC population. 83 (66%) were linked to specialty care and 27 (22%) received HCV treatment. 446 newly diagnosed patients were identified in the Post-LTCC population. 211 (47%) were linked to specialty care and 70 (16%) HCV positive persons were treated. No significant difference was noted between the groups in days between diagnosis and specialty care linkage (Pre-LTCC mean = 120 days; Post-LTCC mean = 102 days). The time from linkage to treatment was significantly longer in Pre-LTCC (260 days) than Post-LTCC persons (152 days), P < 0.05. The average time from diagnosis to treatment in pre-LTCC persons was also significantly longer than in Post-LTCC (332 days vs. 237 days, P < 0.05) (See Table). Conclusion We demonstrate that post-implementation of an LTCC program for HCV, the time between diagnosis and treatment of HCV was significantly reduced. This reduction, however, did not seem to be due to faster linkage to specialty care. A limitation of the study is that differences in HCV care (insurance restrictions, availability of new regimens) between the pre-LTCC and post-LTCC period were not considered. Although the linkage rate in the post-LTCC period was lower, some patients in post-LTCC may still be awaiting linkage. While there was an observed reduction in time between linkage and treatment, further research is needed to determine the causes of this reduction. Disclosures All authors: No reported disclosures.

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Strategies for Hepatitis C Testing and Linkage to Care for Vulnerable Populations: Point-of-Care and Standard HCV Testing in a Mobile Medical Clinic

Journal of Community Health ◽

10.1007/s10900-014-9932-9 ◽

2014 ◽

Vol 39 (5) ◽

pp. 922-934 ◽

Cited By ~ 46

Author(s):

Jamie P. Morano ◽

Alexei Zelenev ◽

Andrea Lombard ◽

Ruthanne Marcus ◽

Britton A. Gibson ◽

...

Keyword(s):

Hepatitis C ◽

Vulnerable Populations ◽

Point Of Care ◽

Linkage To Care ◽

Medical Clinic ◽

Hcv Testing

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Linkage to Hepatitis C Care Following Release from Jail: A Prospective, Single Arm Clinical Trial

10.21203/rs.2.10021/v1 ◽

2019 ◽

Author(s):

Matthew Jiro Akiyama ◽

Devin Columbus ◽

Ross MacDonald ◽

Alison O Jordan ◽

Jessie Schwartz ◽

...

Keyword(s):

Clinical Trial ◽

Hepatitis C ◽

Patient Navigation ◽

Transitional Care ◽

Public Health Problem ◽

Linkage To Care ◽

Virologic Response ◽

Major Public Health Problem ◽

Hcv Treatment ◽

Community Healthcare

Abstract Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial to assess the rate and factors associated with linkage to HCV care after incarceration associated with a combined transitional care coordination (TCC) and patient navigation intervention. Results: During the intervention, n=84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years (SD=12). Of those who returned to the community, 26 (31%) linked to HCV care within a mean of 29 days (SD=25); 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, and 7 (8%) had documentation of sustained virologic response. Expressing a preference to be linked to the participant’s existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant’s wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement.

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Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia

Harm Reduction Journal ◽

10.1186/s12954-021-00485-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anneli Uusküla ◽

Ave Talu ◽

Jürgen Rannap ◽

David M. Barnes ◽

Don Des Jarlais

Keyword(s):

Hepatitis C ◽

Point Of Care ◽

Antibody Test ◽

Hcv Rna ◽

Test Results ◽

Blood Draw ◽

Persons Who Inject Drugs ◽

Oral Swab ◽

High Prevalence ◽

Hcv Antibody

Abstract Background Between December 2018 and January of 2019, we evaluated the accuracy of the point-of-care Hepatitis C (HCV) antibody test (POC; OraQuick HCV) used at a community-based needle and syringe exchange program serving persons who inject drugs in Tallinn, Estonia. Methods We compared the results of screening for HCV antibodies by OraQuick (oral swab) and enzyme immunoassay (EIA; blood draw) and assessed test results implications in a high prevalence setting. Findings Of the 100 participants, 88 (88%) had reactive POC test results, and 93 were HCV antibody positive on EIA testing. Sensitivity, specificity and negative predictive value (NPV) for the POC assay with EIA as the relevant reference test were as follows: 94.6% (95% CI 90.0–99.2%), 100% and 58.3% (95% CI 30.4–86.2%). Of the 12 testing, HCV-negative with the POC only 7 (58.3%) were true negatives. Conclusions Oral swab rapid testing HCV screening in this nonclinical setting was sensitive and specific but had unacceptably low NPV. In high prevalence settings, POC tests with high sensitivity and that directly measure HCV RNA may be warranted.

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Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053195 ◽

2017 ◽

Vol 94 (3) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

James Blain Johnston ◽

Joss N Reimer ◽

John L Wylie ◽

Jared Bullard

Keyword(s):

Viral Load ◽

Hiv Testing ◽

Clinical Outcomes ◽

Point Of Care ◽

Age Groups ◽

Linkage To Care ◽

Hiv Positive ◽

Hiv Status ◽

Viral Load Suppression ◽

Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

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Integrated, Co-located, Telemedicine-based Treatment Approaches for Hepatitis C Virus Management in Opioid Use Disorder Patients on Methadone

Clinical Infectious Diseases ◽

10.1093/cid/ciy899 ◽

2018 ◽

Vol 69 (2) ◽

pp. 323-331 ◽

Cited By ~ 15

Author(s):

Andrew H Talal ◽

Phyllis Andrews ◽

Anthony Mcleod ◽

Yang Chen ◽

Clewert Sylvester ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Multiple Correspondence Analysis ◽

Opioid Use Disorder ◽

Hcv Rna ◽

Directly Observed Therapy ◽

Opioid Use ◽

Hcv Treatment ◽

Opioid Substitution Therapy ◽

Direct Acting

Abstract Background Despite high hepatitis C virus (HCV) prevalence, opioid use disorder (OUD) patients on methadone rarely engage in HCV treatment. We investigated the effectiveness of HCV management via telemedicine in an opioid substitution therapy (OST) program. Methods OUD patients on methadone underwent biweekly telemedicine sessions between a hepatologist and physician assistant during the entire HCV treatment course. All pretreatment labs (HCV RNA, genotype, and noninvasive fibrosis assessments) were obtained onsite and direct-acting antivirals were coadministered with methadone using modified directly observed therapy. We used multiple correspondence analysis, least absolute shrinkage and selection operator, and logistic regression to identify variables associated with pursuit of HCV care. Results Sixty-two HCV RNA–positive patients (24% human immunodeficiency virus [HIV] infected, 61% male, 61% African American, 25.8% Hispanic) were evaluated. All patients were stabilized on methadone and all except 4 were HCV genotype 1 infected. Advanced fibrosis/cirrhosis was present in 34.5% of patients. Of the 45 treated patients, 42 (93.3%) achieved viral eradication. Of 17 evaluated patients who were not treated, 5 were discontinued from the drug treatment program or did not follow up after the evaluation, 2 had HIV adherence issues, and 10 had insurance authorization issues. Marriage and a mental health diagnosis other than depression were the strongest positive predictors of treatment pursuit, whereas being divorced, separated, or widowed was the strongest negative predictor. Conclusions HCV management via telemedicine integrated into an OST program is a feasible model with excellent virologic effectiveness. Psychosocial and demographic variables can assist in identification of subgroups with a propensity or aversion to pursue HCV treatment.

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Attitudes and potential barriers towards hepatitis C treatment in patients with and without HIV coinfection

International Journal of STD & AIDS ◽

10.1177/0956462417725462 ◽

2017 ◽

Vol 29 (4) ◽

pp. 334-340 ◽

Cited By ~ 3

Author(s):

PR Allyn ◽

SM O’Malley ◽

J Ferguson ◽

CH Tseng ◽

KW Chew ◽

...

Keyword(s):

Hepatitis C ◽

Los Angeles ◽

Treatment Preferences ◽

Study Cohort ◽

Hcv Treatment ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Hepatitis C Treatment ◽

Potential Barriers ◽

Hiv Coinfection

This study aimed to assess attitudes and potential barriers towards treatment in patients with hepatitis C virus (HCV) infection, comparing those with and without HIV coinfection. A cross-sectional survey of 82 HCV-infected adults with and without HIV was conducted in greater Los Angeles between November 2013 and July 2015. Overall, there were 53 (64.6%) with HIV coinfection, 20 (25.0%) with self-reported cirrhosis, and 22 (26.8%) with a history of prior HCV treatment. Of all, 93.2% wanted HCV treatment, but 45.9% were unwilling/unable to spend anything out of pocket, 29.4% were waiting for new therapies, and 23.5% were recommended to defer HCV treatment. HIV/HCV-coinfected patients were more likely to want treatment within one year (90.2% versus 68.2%, p = 0.02), more willing to join a clinical trial (74.5% versus 8.0%, p < 0.01), more willing to take medications twice daily (86.3% versus 61.5%, p = 0.01), and more likely to prefer hepatitis C treatment by an infectious diseases/HIV physician (36.7% versus 4.0%, p < 0.01). Of all, 77.1% of coinfected patients were willing to change antiretroviral therapy if necessary to treat HCV, but only 48.0% of patients were willing to take a medication if it had not been studied in HIV-positive patients. Treatment preferences differ between HIV/HCV-coinfected and HCV-monoinfected patients. Despite a strong willingness among the study cohort to start HCV treatment, other factors such as cost, access to medications, and provider reluctance may be delaying treatment initiation.

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932. Universal Hepatitis C Virus Screening in a Tennessee Tertiary Care Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.072 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S31-S32 ◽

Cited By ~ 1

Author(s):

Cody A Chastain ◽

Jakea Johnson ◽

Karen Miller ◽

Katie Moore ◽

Amanda Lako ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Tertiary Care ◽

Linkage To Care ◽

Hcv Rna ◽

Grant Recipient ◽

Age Cohort ◽

Hcv Antibody ◽

Hcv Screening

Abstract Background Despite hepatitis C virus (HCV) age cohort and risk factor screening recommendations, many at-risk individuals remain undiagnosed. Current screening practices may not adequately capture those at high risk for infection, especially in regions with increasing injection drug use (IDU). Universal HCV screening in a Tennessee tertiary care emergency department (ED) was introduced to help define regional epidemiology and to improve diagnosis and linkage to care. Methods This screening program was implemented in the Vanderbilt University Medical Center ED. Adult patients who underwent phlebotomy for clinical purposes were offered HCV screening. Samples were initially tested for HCV antibodies; if positive, samples were reflexed for HCV RNA testing. Patients with positive HCV RNA tests (i.e., active HCV infection) were notified, counseled, and offered linkage to care. Results A total of 11,637 screening tests were performed between April 1, 2017 and March 31, 2018, with 1,008 (8.7%) HCV antibody positive and 488 (4.2%) RNA positive. Of note, 81 (0.7%) were HCV antibody positive but RNA testing could not be performed due to insufficient sample volume. Several notable populations had high rates of HCV (Table 1). Importantly, 3.9% of people not born between 1945 and 1965 were HCV RNA positive, and they were the majority (63.5%) of patients with active HCV (Table 2). A minority (31.6%) of those with active HCV had a known history of IDU (Table 2). Conclusion HCV is common among patients presenting for emergency care at a Tennessee tertiary care ED. Universal screening identified many infections that would have been missed using age cohort and risk factors alone. ED HCV screening may be a useful method to augment guideline-based testing and intervene among populations not consistently screened. Disclosures C. A. Chastain, Gilead Sciences, Inc.: Grant Investigator and Research Contractor, Grant recipient and Research support. J. Johnson, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. K. Miller, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. J. H. Han, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. W. H. Self, Gilead Sciences, Inc.: Grant Investigator, Grant recipient.

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