Faculty Opinions recommendation of Opt-out HIV and Hepatitis C Testing at the Dallas County Jail: Uptake, Prevalence, and Demographic Characteristics of Testers.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection are common in the criminal justice system. We offered opt-out HIV/HCV testing at the Dallas County Jail during intake from June 2015 to November 2016, after which testing was integrated into routine phlebotomy processes. The uptake of testing increased from 12.9% (118/915) in June 2015 to 80.5% (269/334) in January 2016. HIV was confirmed in 1.0% (30/3155) of inmates; 6 were new diagnoses and all were linked to care. HCV antibody positivity was found in 16.4% (500/4042) of inmates. Sixty percent (155/258) of HCV-positive inmates born between 1945 and 1965 (ie, baby boomers) were non-Hispanic black, whereas 56.2% (136/242) born after 1965 were non-Hispanic white. Testing only baby boomers would have missed approximately half of HCV infections, predominantly among young, non-Hispanic white people. Future efforts should expand HIV and HCV testing in jails, as it is feasible, acceptable, and increases prevention and engagement in care for a high-prevalence, hard-to-reach population.

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1064. Hepatitis C Epidemiology at the Dallas County Jail: A Changing Demographic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1250 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S560-S561

Author(s):

Emily Hoff ◽

Andrea E Warden ◽

Ruby Taylor ◽

Ank E Nijhawan

Keyword(s):

Hepatitis C ◽

P Value ◽

Hcv Rna ◽

Birth Cohorts ◽

Blood Draw ◽

Demographic Trends ◽

County Jail ◽

Dallas County ◽

Routine Blood ◽

Prevalence Ratios

Abstract Background Nearly 1 in 3 people living with HCV pass through the CJ system each year. As a result, the CJ system is a crucial location for Hepatitis C screening, education and linkage to care. We aim to 1) identify the prevalence and incidence of HCV and 2) evaluate HCV demographic trends at a large urban jail. Methods Universal opt-out HCV testing was offered in four separate testing cycles from 2015 to 2019 to any individual undergoing a routine blood draw at the Dallas County Jail (N=14490; Figure 1). HCV antibody (Ab) assay (LabCorp) was used with reflex RNA testing added on in 2017. Demographic variables were extracted from the electronic medical record for all tested, with risk factors collected from those who tested positive for HCV Ab (HCV Ab+). Multivariate logistic regression was performed. Figure 1. HCV Ab and HCV RNA positivity among people screened for HCV in the Dallas County Jail from 2015 to 2019 (N=14490). Results The prevalence of HCV Ab+ was 16.7% in the Dallas County Jail; 75.3% of those who tested HCV Ab+ were also HCV RNA+ (Figure 1). The HCV Ab+ incidence rate was 13.5 cases per 1000 person-years. People who were HCV Ab+ were more frequently (adjusted odds ratio [95% confidence interval], p-value): older (1.07 (1.06-1.07), p< 0.001), female (1.24 [1.07-1.44], p=0.004), white (2.12 [1.83-2.45], p< 0.001), and in the birth cohort 1945-65 (1.79 [1.44-2.23], p< 0.001; Table 1). In earlier birth cohorts (1940s), black men were more often HCV Ab+; in more recent birth cohorts (1990s), white and Hispanic females were more often HCV Ab+ (Figure 2). Among individuals who tested HCV Ab+, IDU was more frequently reported by white individuals, particularly women, compared to black individuals (p< 0.001; Figure 3). Table 1. Demographic predictors of Hepatitis C Antibody positivity among those undergoing routine blood draws from 2015-19 at the Dallas County Jail (AIC 7041; BIC 7048; df 10; p<0.001). Figure 2. Trends of Hepatitis C Antibody prevalence and demographic prevalence ratios by birth year (prevalence ratio= proportion with disease/proportion with exposure) among people at the Dallas County Jail screened from 2017-2019 (N=10183). Demographic prevalence ratios were categorized by race (White, Hispanic, Black) and gender (Male, Female) into six categories. Gray bars represent the overall prevalence of HCV Ab+ by birth year. Figure 3. The racial demographics of injection drug use by gender among those who tested HCV Ab positive at the Dallas County Jail in 2017-2018 (n=672; total population p<0.001; male p=0.004; female p=0.008). Conclusion The high prevalence and incidence of HCV at the Dallas County Jail argues for routine, universal testing and linkage to treatment. Additionally, demographic trends mirror the IDU epidemic and have valuable implications for risk reduction and treatment interventions. Disclosures Ank E. Nijhawan, MD, MPH, Gilead (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)

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964. Opt-Out HIV- Hepatitis C (HCV) Testing at a Primary Care Resident Clinic in Columbia, SC: Who Gets Tested and Who Opts Out of Testing?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1150 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S512-S512

Author(s):

Jodian Pinkney ◽

Divya Ahuja ◽

Caroline Derrick ◽

Martin Durkin

Keyword(s):

Primary Care ◽

Hiv Testing ◽

Demographic Variables ◽

Demographic Characteristics ◽

Categorical Variables ◽

Newly Diagnosed ◽

Opting Out ◽

Opt Out ◽

Primary Care Resident ◽

Hcv Testing

Abstract Background South Carolina (SC) remains one of the most heavily affected states for both HIV and HCV infections. Males account for the majority of cases. Implementation of universal opt-out testing has improved screening rates but not much has been published describing the characteristics of those who opt out of testing. This becomes important as 10-50% of patients have opted out in previous studies. Methods Between February and August 2019, we conducted a quality improvement (QI) project which implemented opt- out HIV-HCV testing at a single primary care resident clinic in SC with the primary aim of increasing screening rates for HIV-HCV by 50%. Secondary aims included describing the demographic characteristics of the opt-out population. Persons were considered eligible for testing if they were between the ages of 18-65 years for HIV and 18-74 years for HCV. This was prior to the USPSTF 2020 guidelines which recommend HCV screening for adults aged 18-79 years. A retrospective chart review was used to obtain screening rates, opt status and demographic data. Logistic regression and the firth model were used to determine linkages between categorical variables. We present 3-month data. Results 1253 patients were seen between May 1, 2019- July 31, 2019 (See Table 1). 985 (78%) were eligible for HIV testing. 482 (49%) were tested for HIV as a result of our QI project and all tests were negative. 212 (22%) of eligible patients opted out of HIV testing. Males were 1.59 times more likely to opt out (p=0.008). (see Table 2,3) Regarding HCV, 1136 (90.7%) were deemed eligible for testing. 503 (44%) were tested for HCV as a result of our QI project. 12 (2.4%) were HCV antibody positive with viremia. 11 (90%) of antibody positive with viremia cases were in the 1945-1965 birth cohort (see Table 4). 244 (21%) opted out of HCV testing. Males and persons without a genitourinary chief complaint were more likely to opt out (p=0.02). Table 1: Demographic characteristics of the population seen at the internal medicine resident clinic between May- July 2019 Table 2: Relationship between demographic variables and the odds of being tested for HIV or HCV within the last 12 months. Logistic Model. Table 3: Relationship between demographic variables and the odds of opting out of testing for HIV or HCV. Firth Model. Conclusion Although implementation of routine HIV-HCV opt-out testing led to increased screening rates for both HIV and HCV, roughly 1 in 5 eligible patients chose to opt out of testing. Males were more likely to opt out despite accounting for the majority of newly diagnosed HCV cases. Future studies investigating drivers for opting-out in the male population could improve testing and assist with early diagnosis. Table 4: Characteristics of patients newly diagnosed with HCV positive with viremia. Disclosures All Authors: No reported disclosures

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Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes

Emergency Medicine Journal ◽

10.1136/emermed-2019-208637 ◽

2019 ◽

Vol 37 (2) ◽

pp. 102-105 ◽

Cited By ~ 1

Author(s):

Conor Grant ◽

Sarah O'Connell ◽

Darren Lillis ◽

Anne Moriarty ◽

Ian Fitzgerald ◽

...

Keyword(s):

Hepatitis C ◽

Hepatitis B ◽

Screening Programme ◽

Linkage To Care ◽

Opt Out ◽

B Virus ◽

Lost To Follow Up ◽

The Impact ◽

Test Result

BackgroundWe initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care.MethodsFrom July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months.ResultsOver the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care.ConclusionAlthough high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.

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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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