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

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.307 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Rebecca Eavou ◽

Ellen Almirol ◽

Randee Estes ◽

Michelle Taylor ◽

Mai Pho ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Program Implementation ◽

Linkage To Care ◽

Care Program ◽

Engagement In Care ◽

Hcv Testing

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Use and acceptability of salivary hepatitis C virus testing in an English Young Offender Institution

International Journal of STD & AIDS ◽

10.1177/0956462417696214 ◽

2017 ◽

Vol 28 (12) ◽

pp. 1234-1238 ◽

Cited By ~ 5

Author(s):

Sophie Candfield ◽

Mannampallil I Samuel ◽

David Ritchie ◽

Candice McDonald ◽

Michael Brady ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Drug Use ◽

Point Of Care ◽

Antibody Test ◽

Young Offenders ◽

Young Offender ◽

Sexually Transmitted ◽

The Uk ◽

Hcv Testing

People held in prison are at a high risk of having hepatitis C virus (HCV) and there is a public health drive in the UK to increase HCV testing in prisons and Young Offender Institutions (YOIs), with opt-out testing. There is an oral antibody test for HCV; this project aims to determine its acceptability in an English YOI setting. This project offered HCV oral point-of-care testing (POCT) using the OraQuick® test to 107 male young offenders attending a sexual health service at an English YOI, monitoring HCV positivity and evaluating acceptability. It also investigated young offenders’ histories of sexually transmitted infections (STIs) and drug use. Mean age was 19.1 years. A total of 80.4% reported lifetime drug use and 0.9% reported lifetime drug injection. A total of 19.6% reported previous STIs. One patient (0.9%) was positive for HCV on OraQuick® testing. All patients found the POCT acceptable and one stated he would have refused a fingerprick test had it been the only test available for HCV testing. Salivary rapid HCV testing is acceptable among English YOI inmates. It is not as sensitive or specific as standard HCV tests and is more expensive. In our cohort, HCV positivity was low.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx109 ◽

2017 ◽

Vol 4 (3) ◽

Cited By ~ 28

Author(s):

Mariana Castrejón ◽

Kara W. Chew ◽

Marjan Javanbakht ◽

Romney Humphries ◽

Sammy Saab ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Baby Boomers ◽

Linkage To Care ◽

Care Program ◽

Hcv Rna ◽

Care Coordinator ◽

Hcv Antibody ◽

Hcv Screening

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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What is required from HCV point-of-care tests to reduce the burden of hepatitis C infection? ‘Development and clinical validation of the genedrive point-of-care test for qualitative detection of hepatitis C virus’

Gut ◽

10.1136/gutjnl-2018-316438 ◽

2018 ◽

Vol 67 (11) ◽

pp. 1916-1917 ◽

Cited By ~ 5

Author(s):

Maud Lemoine ◽

Hans L Tillmann

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Point Of Care ◽

Clinical Validation ◽

Hepatitis C Infection ◽

Point Of Care Test ◽

Qualitative Detection ◽

Point Of Care Tests

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Comparison of Rapid Point-of-Care Tests for Detection of Antibodies to Hepatitis C Virus

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv101 ◽

2015 ◽

Vol 2 (3) ◽

Cited By ~ 17

Author(s):

Dennis G. Fisher ◽

Kristen L. Hess ◽

Erlyana Erlyana ◽

Grace L. Reynolds ◽

Catherine A. Cummins ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Hepatitis B ◽

Whole Blood ◽

Point Of Care ◽

Antibody Test ◽

The United States ◽

Blood Tests ◽

Hcv Antibody ◽

Point Of Care Tests

Abstract Background. Hepatitis C is one of the most prevalent blood-borne diseases in the United States. Despite the benefits of early screening, among 3.2 million Americans who are infected with hepatitis C virus (HCV), 50%–70% are unaware of their infection status. Methods. Data were collected between 2011 and 2014, from 1048 clients who were in the following groups: (1) injection drug users, (2) women at sexual risk, (3) gay and bisexual men, and (4) transgender individuals. The sensitivity and specificity of point-of-care tests included (1) the MedMira rapid human immunodeficiency virus (HIV)/HCV antibody test, (2) MedMira hepatitis B (HBV)/HIV/HCV antibody test, (3) Chembio HCV Screen Assay used with both whole blood and (4) oral specimens, (5) Chembio HIV-HCV Assay also used with both whole blood and (6) oral specimens, (7) Chembio HIV-HCV-Syphilis Assay, and (8) OraSure HCV Rapid Antibody Test used with whole blood. The gold standard for the HCV tests were HCV enzyme immunoassay (EIA) 2.0. Results. OraSure had the highest sensitivity at 92.7% (95% confidence interval [CI] = 88.8%–96.5%) followed closely by Chembio's 3 blood tests at 92.1% (95% CI = 87.7%–96.4%), 91.5% (95% CI = 87.2%–95.7%), and 92.3% (95% CI = 88.4%–96.2%). The sensitivities of MedMira HIV/HCV and MedMira HIV/HCV/HBV tests were the lowest, at 79.1% (95% CI = 72.6%–85.5%), and 81.5% (95% CI = 75.2%–87.8%), respectively. Specificity for the OraSure was 99.8% (95% CI = 99.4%–100%); specificity for the Chembio blood tests was 99.2% (95% CI = 98.6%–99.9%), 99.4% (95% CI = 98.8%–99.9%), and 99.3% (95% CI = 98.8%–99.9%); and specificity for the MedMira was100% and 100%. False-negative results were associated with HIV and hepatitis B core antibody serostatus. Conclusions. The OraSure and Chembio blood tests (including those multiplexed with HIV and syphilis) appear to good performance characteristics. This study has identified potential limitations of rapid testing in those testing positive for HIV and HBcAb. There should be discussion of updates to the 2013 CDC guidance.

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2899. Decreased Hepatitis C Virus-Associated Mortality in the US 2014–2017 After New Oral Direct-Acting Antiviral Era

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.177 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S82-S83

Author(s):

Zainab Wasti ◽

Dagan Coppock ◽

Edgar Chou ◽

Dong Heun Lee

Keyword(s):

United States ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Linkage To Care ◽

The United States ◽

Ease Of Use ◽

Hcv Infection ◽

Race And Gender ◽

Direct Acting Antiviral ◽

Direct Acting

Abstract Background Due to the ease of use and low side effect profile of new direct-acting antivirals (DAA), cure rates for hepatitis C virus (HCV) infection have increased in recent years. However, limited data exist addressing the mortality associated with HCV infection since the advent of DAAs. This study examines multiple-cause-of-death (MCOD) data from 2014 to 2017 to describe changes in HCV-associated mortality in the United States. Methods We examined death certificate information from public use MCOD data obtained from the National Center for Health Statistics. All-cause mortality associated with HCV, as defined by ICD-10 codes (B17.1 and B18.2), was evaluated. The age-adjusted crude mortality rate was calculated. Overall HCV-associated mortality, stratified by race and gender, was analyzed. Results From 2014 to 2017, the number of deaths associated with HCV, as listed in death certificates decreased from 19,613 to 17,253. This represents an average of 4% decrease in mortality each year. Crude age-adjusted mortality decreased from 5.01 (95% CI 4.93–5.08) deaths per 100,000 people in 2014 to 4.13 (95% CI 4.07–4.20) deaths per 100,000 people in 2017. Males had age-adjusted mortality of 6.82 (95% CI 6.76–6.88) and females had age-adjusted mortality of 2.59 (95% CI 2.55–2.63). African Americans had age-adjusted mortality of 7.50 (95% CI 7.37–7.63), and whites had age-adjusted mortality of 4.39 (95% CI 4.35–4.42) during the three-year period. Conclusion After the introduction of DAAs in 2014, mortality associated with HCV significantly decreased in the United States. There were differences in mortality rates by gender and race, which may reflect differences in HCV seroprevalence. With the availability of effective, well-tolerated HCV treatment, aggressive HCV screening and linkage to care is warranted, especially in high-risk populations. Disclosures All Authors: No reported Disclosures.

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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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