Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up

Abstract

OBJECTIVE To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation.METHODS Blood donors from 1994 to 2012, identified with positive anti- HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up.RESULTS Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95%CI 1.15–1.71), age under or equal to 50 years (PR = 1.36; 95%CI 1.12–1.65) and non-Caucasians (PR = 1.53; 95%CI 1.27–1.84).CONCLUSIONS About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.

Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil

“…In Brazil, a cross-sectional retrospective study of HCV-infected blood donors showed that about 40% of them did not have access to a specialist and treatment, suggesting the need for improved access to medical care [35]. To the best of our knowledge, there has been no published research evaluating the cascade of care for patients aged > 40 years who have positive anti-HCV serology in Brazil, making this present study the first to demonstrate such an assessment of care.…”

Increasing success and evolving barriers in the hepatitis C cascade of care during the direct acting antiviral era

“…As seen in historical and modern HCV CoC studies, linkage to care after referral was a significant barrier to CoC completion. [ 7 , 8 , 10 , 11 ] Overall, 36% of patients with a scheduled appointment did not complete medical evaluation. Patients with Medicaid were 79% less likely to complete an evaluation as those without Medicaid, even when controlling for other factors.…”

HCV screening, linkage to care, and treatment patterns at different sites across one academic medical center

“…In the cascade of care literature there are several factors which have shown to result in poor linkage to HCV care. These include: the type of insurance a patient has, the health system the patient is operating within, incorrect follow up contact information or no contact information available, homelessness, psychiatric disease, physical illnesses preventing patients from traveling to follow up, and substance abuse[16–19]. Across the five testing sites in this cohort, even though they are patients within the same medical center, there are significant differences in key patient population characteristics, many of which fall into this list.…”