Expanded Hepatitis C Virus (HCV) Testing and Linkage to Care: Program Implementation to Overcome Barriers to Engagement in Care

Abstract Background We implemented and evaluated a large health system-wide hepatitis C virus (HCV) screening and linkage to care program for persons born between 1945 and 1965 (“baby boomers”). Methods An electronic health record (EHR) clinical decision support (CDS) tool for HCV screening for baby boomers was introduced in August 2015 for patients seen in the outpatient University of California, Los Angeles healthcare system setting. An HCV care coordinator was introduced in January 2016 to facilitate linkage to HCV care. We compared HCV testing in the year prior (August 2014–July 2015) to the year after (August 2015–July 2016) implementation of the CDS tool. Among patients with reactive HCV antibody testing, we compared outcomes related to the care cascade including HCV ribonucleic acid (RNA) testing, HCV RNA positivity, and linkage to HCV specialty care. Results During the study period, 19606 participants were screened for HCV antibody. Hepatitis C virus antibody screening increased 145% (from 5676 patients tested to 13930 tested) after introduction of the CDS intervention. Screening increased across all demographic groups including age, sex, and race/ethnicity, with the greatest increases among those in the older age groups. The addition of an HCV care coordinator increased follow-up HCV RNA testing for HCV antibody positive patients from 83% to 95%. Ninety-four percent of HCV RNA positive patients were linked to care postimplementation. Conclusions Introduction of an EHR CDS tool and care coordination markedly increased the number of baby boomers screened for HCV, rates of follow-up HCV RNA testing, and linkage to specialty HCV care for patients with chronic HCV infection.

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Using the electronic medical record to increase testing for HIV and hepatitis C virus in an Appalachian emergency department

BMC Health Services Research ◽

10.1186/s12913-021-06482-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carmen N. Burrell ◽

Melinda J. Sharon ◽

Stephen Davis ◽

Judith Feinberg ◽

Elena M. Wojcik ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Medical Record ◽

Electronic Medical Record ◽

Best Practice ◽

Linkage To Care ◽

Patient Navigators ◽

Hcv Screening ◽

Hcv Testing

Abstract Background The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators. Methods EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%. Conclusion HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.

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Cost-effectiveness and Budgetary Impact of Hepatitis C Virus Testing, Treatment, and Linkage to Care in US Prisons

Clinical Infectious Diseases ◽

10.1093/cid/ciz383 ◽

2019 ◽

Vol 70 (7) ◽

pp. 1388-1396 ◽

Cited By ~ 5

Author(s):

Sabrina A Assoumou ◽

Abriana Tasillo ◽

Claudia Vellozzi ◽

Golnaz Eftekhari Yazdi ◽

Jianing Wang ◽

...

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Liver Fibrosis ◽

Linkage To Care ◽

Cost Effective ◽

Budgetary Impact ◽

Current Drug ◽

Drug Prices ◽

Hcv Testing

Abstract Background Hepatitis C virus (HCV) testing and treatment uptake in prisons remains low. We aimed to estimate clinical outcomes, cost-effectiveness (CE), and budgetary impact (BI) of HCV testing and treatment in United States (US) prisons or linkage to care at release. Methods We used individual-based simulation modeling with healthcare and Department of Corrections (DOC) perspectives for CE and BI analyses, respectively. We simulated a US prison cohort at entry using published data and Washington State DOC individual-level data. We considered permutations of testing (risk factor based, routine at entry or at release, no testing), treatment (if liver fibrosis stage ≥F3, for all HCV infected or no treatment), and linkage to care (at release or no linkage). Outcomes included quality-adjusted life-years (QALY); cases identified, treated, and cured; cirrhosis cases avoided; incremental cost-effectiveness ratios; DOC costs (2016 US dollars); and BI (healthcare cost/prison entrant) to generalize to other states. Results Compared to “no testing, no treatment, and no linkage to care,” the “test all, treat all, and linkage to care at release” model increased the lifetime sustained virologic response by 23%, reduced cirrhosis cases by 54% at a DOC annual additional cost of $1440 per prison entrant, and would be cost-effective. At current drug prices, targeted testing and liver fibrosis–based treatment provided worse outcomes at higher cost or worse outcomes at higher cost per QALY gained. In sensitivity analysis, fibrosis-based treatment restrictions were cost-effective at previous higher drug costs. Conclusions Although costly, widespread testing and treatment in prisons is considered to be of good value at current drug prices.

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Faculty Opinions recommendation of Implementation of a Large System-Wide Hepatitis C Virus Screening and Linkage to Care Program for Baby Boomers.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.731516707.793553782 ◽

2018 ◽

Author(s):

Norah Terrault

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Baby Boomers ◽

Linkage To Care ◽

Care Program ◽

Large System ◽

Virus Screening

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Using the Electronic Medical Record to Increase Testing for HIV and Hepatitis C Virus in An Appalachian Emergency Department

10.21203/rs.3.rs-62404/v1 ◽

2020 ◽

Author(s):

Carmen Burrell ◽

Melinda J. Sharon ◽

Stephen Davis ◽

Judith Feinburg ◽

Elena M. Wojcik ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Medical Record ◽

Electronic Medical Record ◽

Linkage To Care ◽

Primary Objective ◽

Patient Navigators ◽

Hcv Screening ◽

Hcv Testing

Abstract Background: The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary objective of this study was to use the electronic medical record (EMR) to increase HIV and HCV testing in a central Appalachian academic emergency department. A secondary objective was to increase linkage to care using patient navigators. Methods: EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results: The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7,106 (33.7%) patients were screened for HIV and 3,496 (29.2%) patients were screened for HCV, for an overall testing increase of 2,269% and 1,065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100%, and 14% for HCV to 64%. Conclusion: HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks

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Successful Integration of Hepatitis C Virus Point-of-Care Tests into the Denver Metro Health Clinic

AIDS Research and Treatment ◽

10.1155/2013/528904 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

A. Jewett ◽

A. A. Al-Tayyib ◽

L. Ginnett ◽

B. D. Smith

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Point Of Care ◽

Linkage To Care ◽

Antibody Test ◽

Care Program ◽

Ease Of Use ◽

Return Of Results ◽

Health Clinic ◽

Hepatitis C Infection

Background. The Centers for Disease Control and Prevention (CDC) recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV), including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC) testing into standard operations at an urban STD clinic.Methods. The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC). All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative). Focus groups were conducted with triage staff, providers, and linkage-to-care counselors.Results. Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care.Conclusion. DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection.

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Senior Center-Based Hepatitis C Screening in Baltimore

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv217 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 3

Author(s):

Oluwaseun Falade-Nwulia ◽

Risha Irvin ◽

Ayesha McAdams-Mahmoud ◽

Shruti H. Mehta ◽

Alexander Niculescu ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Senior Citizen ◽

Linkage To Care ◽

High Yield ◽

Senior Center ◽

Community Based ◽

Hcv Testing

Abstract Despite significant advancements in hepatitis C virus (HCV) treatments, the majority of individuals infected with HCV remain undiagnosed. We report on senior citizen center-based HCV testing in Baltimore, which revealed a 9.4% prevalence of infection. Our data suggest that community-based HCV testing and linkage to care in appropriate settings is feasible and high yield.

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The 8th Canadian Symposium on Hepatitis C virus: “Improving diagnosis and linkage to care”

Canadian Liver Journal ◽

10.3138/canlivj.2019-0032 ◽

2020 ◽

Vol 3 (1) ◽

pp. 3-14

Author(s):

Sophie E Cousineau ◽

Aysegul Erman ◽

Lewis Liu ◽

Sahar Saeed ◽

Lorraine Fradette ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Linkage To Care

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Testing for Hepatitis C Virus Infection Among Adults Aged ≥18 in the United States, 2013-2017

Public Health Reports ◽

10.1177/00333549211047236 ◽

2021 ◽

pp. 003335492110472

Author(s):

Hope King ◽

J. E. Soh ◽

William W. Thompson ◽

Jessica Rogers Brown ◽

Karina Rapposelli ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

The United States ◽

Hcv Infection ◽

High School Education ◽

Related Risk ◽

Hcv Testing

Objective Approximately 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. The objective of our study was to describe demographic and socioeconomic characteristics, liver disease–related risk factors, and modifiable health behaviors associated with self-reported testing for HCV infection among adults. Methods Using data on adult respondents aged ≥18 from the 2013-2017 National Health Interview Survey, we summarized descriptive data on sociodemographic characteristics and liver disease–related risk factors and stratified data by educational attainment. We used weighted logistic regression to examine predictors of HCV testing. Results During the study period, 11.7% (95% CI, 11.5%-12.0%) of adults reported ever being tested for HCV infection. Testing was higher in 2017 than in 2013 (adjusted odds ratio [aOR] = 1.27; 95% CI, 1.18-1.36). Adults with ≥some college were significantly more likely to report being tested (aOR = 1.60; 95% CI, 1.52-1.69) than adults with ≤high school education. Among adults with ≤high school education (but not adults with ≥some college), those who did not have health insurance were less likely than those with private health insurance (aOR = 0.78; 95% CI, 0.68-0.89) to get tested, and non–US-born adults were less likely than US-born adults to get tested (aOR = 0.77; 95% CI, 0.68-0.87). Conclusions Rates of self-reported HCV testing increased from 2013 to 2017, but testing rates remained low. Demographic characteristics, health behaviors, and liver disease–related risk factors may affect HCV testing rates among adults. HCV testing must increase to achieve hepatitis C elimination targets.

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