Prevalence of false-positive hepatitis C antibody results, National Health and Nutrition Examination Study (NHANES) 2007–2012

101

Despite effective treatment for chronic hepatitis C (CHC), deficiencies in diagnosis and access preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record (EHR) based prompt on HCV screening rates in baby boomers in primary care, and access to specialty care and treatment among those newly diagnosed. We implemented an EHR based “Best Practice Advisory” (BPA) that prompted primary care providers (PCPs) to perform HCV screening for patients seen in primary care clinic: 1) born between 1945–1965; 2) lacked a prior diagnosis of HCV infection; and 3) lacked prior documented anti-HCV testing. The BPA had associated educational materials, order set, and streamlined access to specialty care for newly diagnosed patients. Pre and post BPA screening rates were compared and care of newly diagnosed patients analyzed. In the 3 years prior to BPA implementation, 52,660 baby boomers were seen in primary care clinics, and 28% were screened. HCV screening increased from 7.6% for patients with a PCP visit in the 6 months prior to BPA to 72% over the 1-year post BPA. Of 53 newly diagnosed patients, all were referred for specialty care, 11 had advanced fibrosis or cirrhosis, 20 started treatment and 9 achieved SVR thus far. Conclusions Implementation of an EHR based prompt increased HCV screening rates among baby boomers in primary care by 5 fold due to efficiency in determining needs for HCV screening and work-flow design. Streamlined access to specialty care enabled patients with previously undiagnosed advanced disease to be cured. This intervention can be easily integrated into EHR systems to increase HCV diagnosis and linkage to care.

Section: Discussionsupporting

confidence: 91%

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Konerman¹,

Thomson²,

Gray³

et al. 2017

101

“…Given that the percentage of HCV antibody–positive patients who received HCV RNA confirmatory testing was >94% at each FQHC, it is unlikely that this variation is due to missing data. It is more likely reflective of the positive predictive value of the HCV antibody test, which generally performs better among populations with a high prevalence of HCV infection compared to those with a low prevalence …”

Section: Discussionmentioning

confidence: 99%

“…It is more likely reflective of the positive predictive value of the HCV antibody test, which generally performs better among populations with a high prevalence of HCV infection compared to those with a low prevalence. (30) Another limitation is that we did not have information on the outcome for roughly 25% of the patients who completed treatment. We worked closely with specialist offices to try and remedy the problem for patients seen and treated off-site.…”

Section: Discussionmentioning

confidence: 99%

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

Coyle

Moorman

Bartholomew³

et al. 2019

Self Cite

Improving care and treatment for persons infected with hepatitis C virus (HCV) can reduce HCV‐related morbidity and mortality. Our primary objective was to examine the HCV care continuum among patients receiving care at five federally qualified health centers (FQHCs) in Philadelphia, PA, where a testing and linkage to care program had been established. Among the five FQHCs, one served a homeless population, two served public housing residents, one served a majority Hispanic population, and the last, a “test and treat” site, also provided HCV treatment to patients. We analyzed data from electronic health records of patients tested for HCV antibody from 2012 to 2016 and calculated the percentage of patients across nine steps of the HCV care continuum ranging from diagnosis to cure. We further explored factors associated with successful patient navigation through two steps of the continuum using multivariable logistic regression. Of 885 chronically infected patients, 92.2% received their RNA‐positive result, 82.7% were referred to an HCV provider, 69.4% were medically evaluated by the provider, 55.3% underwent liver disease staging, 15.0% initiated treatment, 12.0% completed treatment, 8.7% were assessed for sustained virologic response (SVR), and 8.0% achieved SVR. Regression results revealed that test and treat site patients were significantly more likely to be medically evaluated (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.82‐4.17) and to undergo liver disease staging (aOR, 1.92; 95% CI, 1.02‐2.86) than patients at the other FQHCs combined. Conclusion: In this US urban setting, over two thirds of HCV‐infected patients were linked to care; although treatment uptake was low overall, it was highest at the test and treat site; scaling up treatment services in HCV testing settings will be vital to improve the HCV care continuum.

“…In cohorts acutely exposed to HCV, spontaneous recovery has been reported in 15%‐45% of cases . Reports derived from large‐scale, prospective cohorts, such as the National Health and Nutrition Examination Survey database, have noted that only approximately 70% of such patients with a positive HCV antibody are viremic . Therefore, not all of the donors designated as “HCV positive” are actually capable of transmitting the virus.…”

Section: Defining Hepatitis C Positivitymentioning

confidence: 99%

The rise of the opioid epidemic and hepatitis C–positive organs: A new era in liver transplantation

Gonzalez

Trotter

2018

The use of hepatitis C virus (HCV)-positive organs in liver transplantation (LT) has increased in the era of direct-acting antiviral therapy. A rising demand for organs, the increased ability to effectively treat HCV infection in the transplant setting, and an unprecedented increase in HCV-positive donors have all contributed to this trend. A recent abrupt rise in opioid use in the United States has resulted in a surge of injection drug use, transmission of HCV, and opioid-related overdose deaths. Geographical areas most affected by the opioid epidemic have experienced a rapid increase in recovery and utilization of HCV-positive donor organs, in which the proportion of deceased donor LTs in the United States from donors who are HCV positive has increased nearly 2-fold within the last 3 years. The prospect of expanding the organ donor pool with HCV-positive donors and achieving acceptable posttransplant outcomes has generated much interest in the areas of liver, kidney, and thoracic transplantation, including the potential for transplanting organs from HCV positive donors into HCV-negative recipients. Developing strategies to ensure appropriate selection of potential recipients of HCV-positive organs, initiating timely antiviral therapy, and defining associated risks will be critical in achieving optimal posttransplant outcomes in this setting. (Hepatology 2018;67:1600-1608).