Strategy for the Micro-Elimination of Hepatitis C among Patients with Diabetes Mellitus—A Hospital-Based Experience

Hepatitis C virus (HCV) infection can induce insulin resistance, and patients with diabetes mellitus (DM) have a higher prevalence of HCV infection. Patient outcomes improve after HCV eradication in DM patients. However, HCV micro-elimination targeting this population has not been approached. Little is known about using electronic alert systems for HCV screening among patients with DM in a hospital-based setting. We implemented an electronic reminder system for HCV antibody screening and RNA testing in outpatient departments among patients with DM. The screening rates and treatment rates at different departments before and after system implementation were compared. The results indicated that the total HCV screening rate increased from 49.3% (9505/19,272) to 78.2% (15,073/19,272), and the HCV-RNA testing rate increased from 73.4% to 94.2%. The anti-HCV antibody seropositive rate was 5.7%, and the HCV viremia rate was 62.7% in our patient population. The rate of positive anti-HCV antibodies and HCV viremia increased with patient age. This study demonstrates the feasibility and usefulness of an electronic alert system for HCV screening and treatment among DM patients in a hospital-based setting.

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Micro-Elimination of Hepatitis C among Patients with Kidney Disease by Using Electronic Reminder System—A Hospital-Based Experience

Journal of Clinical Medicine ◽

10.3390/jcm11020423 ◽

2022 ◽

Vol 11 (2) ◽

pp. 423

Author(s):

Pei-Yuan Su ◽

Wei-Wen Su ◽

Yu-Chun Hsu ◽

Shu-Yi Wang ◽

Ping-Fang Chiu ◽

...

Keyword(s):

Kidney Disease ◽

Hcv Rna ◽

Electronic Reminder ◽

Seropositivity Rate ◽

Reminder System ◽

System A ◽

System P ◽

Hcv Antibody ◽

Outpatient Departments ◽

Hcv Screening

Background: Little is known about the use of an electronic reminder system for HCV screening among patients with kidney disease. In this study, we tried to determine whether reminder systems could improve the HCV screening rate in patients with kidney disease. Methods: Patients with kidney disease were enrolled from August 2019 to December 2020 to automatically screen and order HCV antibody and RNA testing in outpatient departments. Results: A total of 19,316 outpatients with kidney disease were included, and the mean age was 66.5 years. The assessment rate of HCV antibody increased from 53.1% prior to the reminder system to 79.8% after the reminder system (p < 0.001), and the assessment rate of HCV RNA increased from 71% to 82.9%. The anti-HCV seropositivity rate decreased from 7.3% at baseline to 2.5% after the implementation of the reminder system (p < 0.001), and the percentage of patients with detectable HCV RNA among those with anti-HCV seropositivity decreased from 69.1% at baseline to 46.8% (p < 0.001). Conclusions: The feasibility of an electronic reminder system for HCV screening among patients with kidney disease in a hospital-based setting was demonstrated.

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DETEKSI ANTIBODI MULTIPEL HEPATITIS C DALAM DARAH DONOR

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v21i3.738 ◽

2016 ◽

Vol 21 (3) ◽

pp. 261

Author(s):

Ranti Permatasari ◽

Aryati Aryati ◽

Budi Arifah

Keyword(s):

Hepatitis C ◽

Predictive Value ◽

Core Protein ◽

Rapid Test ◽

Antibody Test ◽

Diagnostic Value ◽

Hcv Infection ◽

Antibody Detection ◽

Hcv Rna ◽

Hcv Antibody

Hepatitis C (HCV) infection could be spread by blood transfusion. Screening of HCV in donor blood could prevent HCV infection to the recipient. HCV antibody test using rapid test of multiple antibody detection by immunochromatography method is an easy and rapid test that could detect four HCV antibodies separately. The aim of this study was to evaluate the diagnostic value of antibody HCV using multiple antibody detection rapid test in diagnosing HCV infection. This was an analytical observational study with a cross sectional design. The samples consisted of 42 donors’ blood serum from the Surabaya Branch of the Indonesian Red Cross which underwent HCV infection test using ELISA method. The samples were then tested using PCR HCV RNA as the gold standard and antibody HCV multiple antibodydetection rapid test The diagnostic value of HCV antibody test using multiple antibody detection rapid test by immunochromatography method showed a diagnostic sensitivity of 100%, diagnostic specificity of 75%, positive predictive value of 66.7% and negative predictive value of 100%, a diagnostic efficiency of 83.3%, with a positive probability ratio of 4 times. The most often positive antibody pattern was four (4) positive antibodies (core protein, NS3, NS4 and NS5). Core protein (CP) and NS3 were the most often positive antibodies. Based on this study result, the HCV antibody test using multiple antibody detection rapid test by immunochromatography method has a good diagnostic value.

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DIABETES MELLITUS;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.02.629 ◽

2013 ◽

Vol 20 (02) ◽

pp. 220-226

Author(s):

GHAZANFAR ALI SINDHU, ◽

SADAF NAZ, ◽

FRAZ SAEED QURESHI, ◽

Zaheer Ahmed, ◽

Tamur Islam,

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Hcv Infection ◽

Hcv Rna ◽

Newly Diagnosed

Introduction: Hepatitis C virus (HCV) is a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma(HCC). HCV infection and type 2 diabetes are two common disorders with a high impact on health worldwide. There is growing evidenceto support the concept that HCV infection is a risk factor for developing type 2 Diabetes Mellitus. Both insulin resistance and diabetes canadversely affect the course of chronic hepatitis C, and lead to poor response to antiviral therapy and increased incidence of Hepatocellularcarcinoma. Objective: The objective of the study was to assess the frequency of type 2 Diabetes mellitus in newly diagnosed chronichepatitis C patients presenting in Allied hospital Medical unit II during six month period. Design: Cross sectional study. Setting: Medicalunit-II, Allied Hospital, Faisalabad. Period: 01-08-2009 to 28-02-2010. Material and methods: All newly diagnosed patients of chronichepatitis C on the basis of PCR for HCV-RNA were included in the study. Fasting and two hours postprandial blood sample were tested.Diabetes Mellitus was labeled as per slandered. Results: Out of 180 patients with CHC 19 (10.6%) were found to have Diabetes mellituswhile 161(89.4%) were non-diabetics. Conclusions: There is close association in the development of type 2 diabetes mellitus in patientswith chronic hepatitis C.

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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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Hepatitis C Virus Infection in the Dallas County Jail: Implications for Screening, Prevention, and Linkage to Care

Public Health Reports ◽

10.1177/0033354919874081 ◽

2019 ◽

Vol 134 (6) ◽

pp. 626-633

Author(s):

Caroline M. Abe ◽

Merilyne Aguwa ◽

Michelle Zhao ◽

Jacqueline Sullivan ◽

Esmaeil Porsa ◽

...

Keyword(s):

Risk Factors ◽

Health Insurance ◽

Linkage To Care ◽

Hcv Infection ◽

Hcv Rna ◽

County Jail ◽

Health Insurance Status ◽

Dallas County ◽

Hcv Antibody ◽

Hcv Screening

Objectives: Screening for hepatitis C virus (HCV) infection in jail provides an opportunity to educate and offer care to a high-risk population. We aimed to (1) estimate the prevalence of HCV infection in jail; (2) describe the demographic characteristics, risk factors, and pre-incarceration health insurance status associated with HCV infection; and (3) examine the implementation of HCV screening in jail. Methods: We conducted a retrospective analysis of an opt-out HCV screening program with HCV RNA confirmation and patient education at the Dallas County Jail from April 1 through November 2, 2017. We extracted data on test results, demographic characteristics, and release destination from electronic medical records. A nurse navigator recorded data on patient self-reported risk factors and pre-incarceration health insurance status. Results: Of 4089 incarcerated persons screened, 708 (17.3%) had a positive HCV antibody result. Of these, 641 (90.5%) had an HCV RNA test ordered; 576 (89.9%) had RNA tests completed, of whom 413 (71.7%) had a positive HCV RNA result. Of these 413, 352 (85.2%) received patient education. Half of HCV RNA-positive incarcerated persons (n = 207, 50.1%) were born outside the birth cohort (1945-1965). Among those with HCV infection, commonly reported risk factors were injection drug use (168 of 352; 47.8%) and tattoos (82 of 352; 23.4%). Most incarcerated persons with HCV infection (284 of 350; 81.1%) did not have health insurance. HCV antibody prevalence was higher among incarcerated persons released to prison (232 of 961; 24.1%) than to outside agencies (38 of 403; 9.4%) or the community (178 of 1026; 17.4%). Conclusions: Screening for HCV with RNA confirmation in jail provides an opportunity for disease education, transmission prevention, and navigation to HCV treatment. Future efforts should examine post-incarceration linkage to care.

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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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Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

BMJ Open Quality ◽

10.1136/bmjoq-2018-000577 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000577 ◽

Cited By ~ 1

Author(s):

Smita Bakhai ◽

Naren Nallapeta ◽

Mohammad El-Atoum ◽

Tenzin Arya ◽

Jessica L Reynolds

Keyword(s):

Quality Improvement ◽

Hepatitis C ◽

Nursing Staff ◽

Hcv Rna ◽

Screening Rate ◽

Quality Improvement Team ◽

Positive Rate ◽

Hcv Antibody ◽

Hcv Screening ◽

Improvement Team

Individuals born between 1945–1965 represent 81% of all persons chronically infected with hepatitis C virus (HCV) in the USA and are largely unaware of their positive status. The baseline HCV screening rate in this population in an academic internal medicine clinic at a US hospital was less than 3.0%. The goal was to increase the rate of HCV screening in patients born between 1945 and 1965 to 20% within 24 months. The quality improvement team used the Plan Do Study Act Model. Outcome measures included HCV antibody screening, HCV RNA positive rate and linkage to hepatology care. Process measures included HCV antibody order and completion rates. The quality improvement team performed a root cause analysis and identified barriers for HCV screening and linkage to care. The key elements of interventions included redesigning nursing workflow, use of health information technology and educating patients, physicians and nursing staff about HCV. The HCV screening rate was 30.3% (391/1291) within 24 months. The HCV antibody positive rate was 43.5% (170/391), and HCV RNA positive rate was 95.3% (162/170). HCV infection was diagnosed in 12.5% (162/1291) of patients or 41.4% (162/391) of the screened population. Of those positive, 70% (114/162) were linked to hepatology care within the 24-month project timeframe. Eighty percent of patients seen by a hepatologist were treated with direct-acting antivirals agents. The HCV screening rate was sustained at 25.4% during the post-project 1-year period. Engagement of a multidisciplinary team and education to patients, physicians and nursing staff were the key drivers for success.

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920. Automated Hepatitis C Screening and Linkage to Care among Hospitalized Patients Born Between 1945-1965

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1115 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S551-S551

Author(s):

Julia A Gasior ◽

Rebecca Russell ◽

Vincent Lo Re ◽

Anne Norris ◽

Schenevelyn Bennett ◽

...

Keyword(s):

Hepatitis C ◽

Hospital Admission ◽

Health System ◽

Hospital Admissions ◽

Linkage To Care ◽

The United States ◽

Quality Improvement Initiative ◽

Hcv Rna ◽

Hcv Antibody ◽

Hcv Screening

Abstract Background Hepatitis C virus (HCV) infects 4.1 million people in the United States, of whom 50% are unaware of their status. In 2016, Pennsylvania introduced a law mandating HCV screening for patients born between 1945-1965 in inpatient settings. However, HCV screening during hospital admissions has remained low in part due to limited knowledge on HCV testing requirements, interpretation of results, and treatment approaches. To overcome these barriers, we implemented a quality improvement initiative to automate HCV screening as part of hospital admission order sets, facilitate linkage to HCV treatment, and sought to evaluate its effectiveness. Methods Between September 2020 and May 2021, the automated inpatient HCV screening strategy was implemented at a single 328-bed academic hospital in Philadelphia, PA. Patients born between 1945-1965 without documentation of HCV screening or diagnosis in the electronic medical record had a HCV antibody with reflexive confirmatory RNA assay automatically populated in the admission order set. Admitting providers could opt out of the screening as appropriate. All patients with reactive HCV antibody were approached by the Hepatitis Linkage Team for result disclosure, counseling, and linkage to treatment for those with HCV viremia. Cascade of care was detailed for those linked to providers within the health system. Results During the initial 8 months of the program, 2,203 patients were screened for HCV, identifying 156 with reactive HCV antibody (7.1% seroprevalence). Among 147 with completed HCV RNA assay, 51 were viremic (34.7%). Fourteen viremic patients were not linked to care, including six with a terminal illness, two who declined linkage, and six who did not respond to linkage attempts. Nine were linked to care at other health systems. Among the 28 patients linked to providers in the health system, 50% completed initial visits, 42.8% were prescribed direct acting antivirals (DAA), and 21.4% completed therapy by May 2021. One person achieved sustained virologic response 12 weeks after treatment as of May 2021 (Figure 1). Figure 1. Cascade of HCV Care Among Patients Screened During Hospital Admission from September 2020 to May 2021 Conclusion Automated inpatient HCV screening is a viable strategy to identify people with HCV and facilitate linkage to care. Optimal strategies to ensure patients access and maintain care require further study. Disclosures All Authors: No reported disclosures

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High prevalence of hepatitis C (HCV) in the emergency department (ED) of a London hospital: should we be screening for HCV in ED attendees?

Epidemiology and Infection ◽

10.1017/s0950268815000199 ◽

2015 ◽

Vol 143 (13) ◽

pp. 2837-2840 ◽

Cited By ~ 11

Author(s):

C. ORKIN ◽

E. LEACH ◽

S. FLANAGAN ◽

E. WALLIS ◽

M. RUF ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C ◽

Cost Benefit ◽

Hcv Rna ◽

London Hospital ◽

High Prevalence ◽

Cost Benefit Ratio ◽

Hcv Antibody ◽

Hcv Screening ◽

The Cost

SUMMARYAn unlinked anonymous study was conducted to estimate the prevalence of hepatitis C virus (HCV) infection in emergency department (ED) attendees at a London Hospital. Nine hundred and ninety-seven samples collected over a 12-day period were tested for HCV antibody (Ab) and reactive samples were further tested for HCV RNA. The HCV seroprevalence was 2·6% (26/997) with 1·2% (12/997) HCV RNA positive. A peak HCV RNA-positive prevalence of 4·8% (3/63) was found in males aged 35–44 years, this was compared to 0% (0/136) in males aged <35 years (P = 0·0614) and 1·4% (4/278) in males aged ⩾45 years (P = 0·2415). Assuming the cost for HCV Ab is £6 and HCV RNA is £40 per test, screening ED attendees aged 25–54 years would cost £360 per viraemic infection and identify 82% of those who were HCV RNA positive, yielding the most favourable cost/benefit ratio. HCV screening of ED attendees aged 25–54 years in this population could be an effective way of identifying patients and limit onward transmission.

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