Differences in inpatient and outpatient hepatitis C virus prevalence and linkage to care rates in a safety net hospital hepatitis C screening program

Abstract

Background and Aim: Routine screening for hepatitis C virus (HCV) infection is crucial in identifying the 50% of infected persons unaware of their infection. We added an inpatient screening initiative to our successful outpatient HCV screening program in an urban, safety-net hospital. Methods: From March 2017 to December 2019, HCV screening was performed in inpatient and outpatient settings at Grady Health System. We compared care cascade outcomes, including anti-HCV testing, RNA testing, and linkage to care (LTC) between these settings. Results: A total of 29 751 patients were tested for anti-HCV: 8883 inpatients and 20 868 outpatients. The anti-HCV population was predominantly Black (76.2%) and male (67.9%). The total anti-HCV prevalence was 8.9%, with 14% of inpatients and 6.7% of outpatients testing positive. RNA testing was performed on 86%. The prevalence of active HCV infection was 59.3% in those that were anti-HCV positive; inpatient prevalence was 66%, and outpatient was 53.8%. Of those with active infection, 67.5% were linked to care (57.3% of inpatients and 77.8% of outpatients). Conclusion:We found significant differences in prevalence of anti-HCV and LTC rates between inpatients and outpatients during an HCV screening program. Higher anti-HCV prevalence among inpatients may be due a higher prevalence of non-birth year HCV risk factors. LTC rates were lower in the inpatient setting despite a robust linkage strategy. The striking prevalence of HCV in both settings warrants continued screening, expansion to additional settings, and novel strategies to improve inpatient linkage rates, especially in the setting of new universal HCV screening guidelines.with screening guidelines promulgated by the US Centers for Disease Control and Prevention (CDC), the US Preventive Services Task Force (USPSTF), and state and local public health departments.FOCUS funding supports HIV, HCV, and HBV screening and linkage to the first medical appointment after diagnosis.

HIV and HCV testing at clinical encounters among people who inject drugs, 2013–2018—Opportunities for increased testing and prevention

“…This may be attributed to this hospital's implementation of HIV on the Frontlines of Communities in the United States (FOCUS), a routine opt-out HIV testing initiative that launched in the ED in 2013 and in inpatient settings in 2017. 44 Routine opt-out HCV testing launched in late 2012, 45 but specifically targeted baby boomers and was implemented in the inpatient setting in 2017 46 During recent years, uptake of CDC HIV and HCV testing guidelines has improved among providers in the U.S. 47 Our study showed similar trends, as evidenced by improved testing rates over the course of the study period. However, our results reveal many missed testing opportunities and continued need for testing improvements for PWID in clinical settings.…”

“…This may be attributed to this hospital's implementation of HIV on the Frontlines of Communities in the United States (FOCUS), a routine opt‐out HIV testing initiative that launched in the ED in 2013 and in inpatient settings in 2017 44 . Routine opt‐out HCV testing launched in late 2012, 45 but specifically targeted baby boomers and was implemented in the inpatient setting in 2017 46 and in the ED in 2019, thus not significantly impacting the cohort examined in this study. In April 2020, the hospital expanded from routine HCV screening for baby boomers to universal screening for all individuals aged 18–79 years in both ED and inpatient settings based on the new CDC and U.S. Preventive Services Task Force (USPSTF) guidelines.…”

Large-Scale, Primary Care–Based Hepatitis C Treatment in an Urban, Medically Underserved Patient Population

“…We started by screening those born from 1945 through 1965 on a small scale in our Primary Care Center, and over time we expanded the screening program throughout GHS to include GHS neighborhood health centers, the emergency department, the walk-in clinic, the obstetrics clinics, and the inpatient service. 13,14 We now perform universal screening of all adults as recommended in updated 2020 screening guidelines. 15,16 Hallmarks of the screening program include electronic health record–based screening algorithms and prompts to identify patients eligible for screening and patient navigators to disclose results and link patients to care (the majority at the GLC).…”

“…These efforts from 2012 through 2019 resulted in the screening of more than 42 000 patients, the revealing of a ~6.5% prevalence of HCV exposure among outpatients screened and a 14% prevalence among inpatients screened, the identification of more than 1800 patients with chronic HCV infection, and linkage to care of more than 60% of eligible patients. 13,14 Treatment programs. For patients diagnosed with HCV, the GLC is the primary site for HCV care at GHS.…”

“…Finally, as HCV screening guidelines expanded, we implemented large-scale HCV screening across GHS, which uncovered a high prevalence of HCV exposure among outpatients screened (~6.5%) and inpatients screened (14%) in our health system. 13,14 Systematic screening, coupled with linkage to care, which uses patient navigation and program management, fueled growth in the GLC patient population.…”