A Surveillance-Based Hepatitis C Care Cascade, New York City, 2017

Moore, Miranda S.; Bocour, Angelica; Laraque, Fabienne; Winters, Ann

doi:10.1177/0033354918776641

Cited by 13 publications

(12 citation statements)

References 12 publications

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“…LTC was 40.6% in our study, lower than other integrated health systems that utilize best practice interventions and patient navigators [14, 15, 17, 18]. We found that 34.6% of those LTC began DAA therapy, which is higher than in some studies [24–26] but not others [27]. Whether this rate was due to our patients linking early or that greater than 90% of our patients had insurance is unclear.…”

Section: Discussioncontrasting

confidence: 70%

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Risk Factors Associated with Linkage to Care among Suburban Hepatitis C-Positive Baby Boomers and Injection Drug Users

et al. 2019

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Introduction Suffolk County, located in Eastern Long Island, has been an epicenter for the opioid epidemic in New York State, yet no studies have examined hepatitis C virus (HCV) prevalence in this population. Additionally, few studies have assessed barriers for linkage to care (LTC) to HCV treatment in people who inject drugs (PWID), a high-risk HCV cohort. We aimed to determine prevalence of HCV infection in a suburban medical center and to assess risk factors associated with LTC in HCV-positive baby boomers and young PWID. Methods A retrospective chart review was carried out on adult patients with ICD-9/10 diagnostic codes for HCV from January 2016 to December 2018 at Stony Brook Medicine. Data collected included sociodemographics, RNA serostatus, LTC, health insurance, employment, past medical or psychiatric history, and substance or injection drug use. Results Overall, 27,049 individuals were screened for HCV and 1017 were HCV seropositive (3.8%), 437 (42.9%) were HCV RNA-positive and 153 (40.6%) achieved LTC. In multivariate analysis, living with cirrhosis was associated with a positive LTC. Medicaid or Medicare insurance was associated with a negative LTC. Intravenous drug users were more likely to be young and have concomitant polysubstance use and psychiatric disease. A bimodal distribution of HCV-positives is present in our population. Conclusion Those with liver cirrhosis are more likely to achieve LTC, as are those with private insurance. Public health efforts to promote awareness of HCV and to facilitate access to treatment among PWID are needed.

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Section: Discussioncontrasting

confidence: 70%

“…However, it must be noted that due to our low LTC, there was not a large cohort to assess for initiation or completion of DAA therapy. Among PWID, 27.8% achieved LTC, lower than reported elsewhere [27, 28]. However, 40% were started on DAA therapy, which is higher than that found in other reports [27].…”

Section: Discussioncontrasting

confidence: 58%

Risk Factors Associated with Linkage to Care among Suburban Hepatitis C-Positive Baby Boomers and Injection Drug Users

et al. 2019

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“…With the high efficacy of new direct antiviral agents (DAAs), in Brazil, the challenge exists in need to identify and treat infected patients [19]. However, the lack of an efficient cascade of care for chronic HCV infection in Brazil hinders the diagnosis of the disease and access to treatment, which are the most critical factors for eliminating HCV infection and reducing HCV-related mortality [20]. This descriptive, observational, cross-sectional study aimed to evaluate the efficiency of the cascade of care for HCV-positive patients among people aged > 40 years in Brasilia, Brazil.…”

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confidence: 99%

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

et al. 2020

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Background: Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals.Methods: This cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography.Results: The prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication. Conclusions:The prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis.

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“…Access to HCV treatment in the community has improved in the DAA era, with 52% of those with a positive HCV RNA test in NYC between 2014 and 2017 initiating treatment [7] . However, ongoing barriers to care limit progression through the HCV care cascade for many incarcerated individuals [ 3 , [28] , [29] ].…”

Section: Discussionmentioning

confidence: 99%

“…In the community, the HCV care cascade has improved during the direct-acting antiviral (DAA) treatment era [ 6 , 7 ], but incarcerated populations still face barriers to diagnosis and care [8] , [9] , [10] . With 10.7 million admissions nationally in 2018, US jails are primarily remand settings with high turnover (mean length of stay was 25 days) [11] .…”

Section: Introductionmentioning

confidence: 99%

The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014–2017

et al. 2020

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Background High patient turnover presents challenges and opportunity to provide hepatitis C virus (HCV) care in US jails (remand facilities). This study describes the HCV care cascade in the New York City (NYC) jail system during the direct-acting antiviral (DAA) treatment era. Methods Patients admitted to the NYC jail system from January 2014 through December 2017 were included in this retrospective cohort analysis. We describe rates of screening, diagnosis, linkage to jail-based care, and treatment among the overall cohort, and among subgroups with long jail stays (≥120 days) or frequent stays (≥10 admissions). The study protocol was approved by a third-party institutional review board (BRANY, Lake Success, NY). Findings Among the 121,371 patients in our analysis, HCV screening was performed in 40,219 (33%), 4665 (12%) of whom were viremic, 1813 (39%) seen by an HCV clinician in jail, and 248 (5% of viremic patients) started on treatment in jail. Having a long stay (adjusted risk ratio [aRR] 8·11, 95% confidence interval [CI] 6·98, 9·42) or frequent stays (aRR 1·51, 95% CI 1·04, 2·18) were significantly associated with being seen by an HCV clinician. Patients with long stays had a higher rate of treatment (14% of viremic patients). Sustained virologic response at 12 weeks was achieved in 147/164 (90%) of patients with available virologic data. Interpretation Jail health systems can reach large numbers of HCV-infected individuals. The high burden of HCV argues for universal screening in jail settings. Length of stay was strongly associated with being seen by an HCV clinician in jail. Treatment is feasible among those with longer lengths of stay. Funding None.

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A Surveillance-Based Hepatitis C Care Cascade, New York City, 2017

Abstract: A substantial gap exists between confirming HCV infection and initiating treatment, even in the era of direct-acting antivirals. Using this cascade, we will monitor progress in improved treatment and cure of HCV in NYC.

Cited by 13 publications

References 12 publications

Risk Factors Associated with Linkage to Care among Suburban Hepatitis C-Positive Baby Boomers and Injection Drug Users

Risk Factors Associated with Linkage to Care among Suburban Hepatitis C-Positive Baby Boomers and Injection Drug Users

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

The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014–2017

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