scholarly journals Delays and gaps in progressing through the hepatitis C virus cascade of care: An underserved safety-net hospital experience

2020 ◽  
Vol 8 (4) ◽  
pp. 261-267
Author(s):  
Chantal Gomes ◽  
Dina Ginzberg ◽  
Robert J. Wong
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
African Americans ◽  
Median Time ◽  
Linkage To Care ◽  
Safety Net ◽  
Hcv Treatment ◽  
Safety Net Hospital ◽  
Cascade Of Care ◽  
Chronic Hcv

AbstractBackground and ObjectiveWhile highly effective hepatitis C virus (HCV) therapies exist, gaps in the cascade of care remain. Disparities in the HCV cascade are prominent among underserved safety-net populations. We aim to evaluate the HCV cascade among an urban safety-net cohort of HCV patients.MethodsWe retrospectively evaluated adults with chronic HCV to determine rates of linkage to care (LTC), retention to care, and receiving HCV treatment from 2002 to 2018. Comparisons between groups utilized Chi-square testing; comparisons of median time to LTC and HCV treatment were evaluated with Student’s t-test and analysis of variance.ResultsAmong 600 chronic HCV patients (60.7% male, 20.7% non-Hispanic white, 49.2% African American, 92.5% treatment naïve, 26.8% cirrhosis), successful LTC within one year of HCV diagnosis was 57.7%, among which, 91.6% were successfully retained into care. In those with successful LTC, 72.6% received HCV treatment, 91.8% completed treatment, and 89% achieved SVR12. Women with HCV experienced longer delays from LTC to HCV treatment (331 vs. 206 days in men, P < 0.05), as did African Americans (280 vs. 165 days in non-Hispanic whites, P < 0.05). Compared to the non-Hispanic whites, HCV treatment was lower in African Americans (70.4% vs. 74.4%, P < 0.05).ConclusionWomen with HCV experienced significant delays along the HCV cascade, with median time of over 2 years from diagnosis to treatment. African Americans also experienced significant delays along the HCV cascade of care. However, sex and race/ethnicity were not found to be significant predictors of overall LTC or treatment.

scholarly journals 2202. The Hepatitis C Virus Cascade of Care at Stony Brook University Hospital: Risk Factors for Linkage to Care

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S650-S650
Author(s):  
Audun Lier ◽  
Kalie Smith ◽  
Silvia Bronson ◽  
Teresa Khoo ◽  
Kerim Odekon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Linkage To Care ◽  
University Hospital ◽  
Cascade Of Care

scholarly journals Relationship Between Hepatitis C Clinical Testing Site and Linkage to Care

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Sabrina A. Assoumou ◽  
Wei Huang ◽  
C. Robert Horsburgh ◽  
Mari-Lynn Drainoni ◽  
Benjamin P. Linas
Keyword(s):  
Hepatitis C ◽  
Private Insurance ◽  
Linkage To Care ◽  
Safety Net ◽  
Hcv Rna ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Control And Prevention ◽  
Multivariable Regression ◽  
Testing Site

Abstract Background.  The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing of the population born between 1945 and 1965 with follow-up RNA testing for those with reactive serology. To increase the rate of diagnosis, testing may be considered in settings other than outpatient clinics (OC), such as inpatient wards (IP) or emergency department (ED). Methods.  We used electronic medical records to create a retrospective cohort with reactive HCV serology between 2005 and 2010 at an urban safety net hospital. We determined factors associated with linkage to HCV care as measured by HCV RNA testing, and we evaluated the rate of linkage to care according to diagnosis location (OC, IP, or ED). Results.  Individuals, 37 828, were tested and 5885 (16%) were reactive. Seropositivity was similar across all sites. Of the 4466 patients who met inclusion criteria, 3400 (76%) were diagnosed in the OC, whereas 967 (22%) and 99 (2%) were tested in the IP and the ED, respectively. A total of 2135 (48%) underwent HCV RNA testing. Using multivariable regression modeling, the following factors were independently associated with HCV RNA testing: diagnosis in the OC (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.42–1.90); age at diagnosis in decades (OR, 0.98; 95% CI, 0.98–0.99); private insurance (OR, 1.17; 95% CI, 1.01–1.34); and ≥10 visits after diagnosis (OR, 2.15; 95% CI, 1.89–2.44). Conclusion.  There is an opportunity to increase HCV diagnosis by testing in sites other than the OC, but this opportunity needs to be coupled with robust initiatives to improve linkage to care.

Treatment of Chronic Hepatitis C Virus Infection With Crushed Ledipasvir/Sofosbuvir Administered via a Percutaneous Endoscopic Gastrostomy Tube

2017 ◽  
Vol 31 (5) ◽  
pp. 522-524 ◽  
Author(s):  
Lauren Jindracek ◽  
Jennifer Stark
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Hcv Treatment ◽  
Endoscopic Gastrostomy ◽  
Chronic Hepatitis C Virus ◽  
Chronic Hcv Infection ◽  
Chronic Hcv ◽  
Peg Tube

Introduction: Ledipasvir/sofosbuvir (Harvoni®) is a fixed-dose tablet indicated for the treatment of chronic hepatitis C virus (HCV) infection. There are currently no data available on the safety and efficacy of crushed ledipasvir/sofosbuvir tablets. Case Summary: This report describes the first documented case of successful treatment of chronic HCV infection in a patient crushing ledipasvir/sofosbuvir for administration via a percutaneous endoscopic gastrostomy (PEG) tube. The patient was treatment experienced and had evidence of compensated cirrhosis. Treatment duration was 24 weeks, and HCV RNA was undetectable 12 weeks after completion of treatment (SVR12) which is the accepted measure of a clinical cure. Discussion: Issues may arise during or prior to starting HCV treatment that necessitate crushing tablets. Stopping or interrupting HCV treatment could lead to development of resistance or treatment failure. Conclusion: This is the first published case in which crushed ledipasvir/sofosbuvir administered via a PEG tube is documented as a safe and effective option for treatment of chronic HCV infection.

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