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

Abstract

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.

Hepatitis C Prevalence on the Rise but Screening at Safety Net Institutions Lagging behind

“…Men were more likely to be exposed than women, correlating with the male-to-female HCV prevalence ratio of 2.3 found nationally by Bradley et al [11]. Our hospital is a safety net hospital located in Long Island, NY, where the high prevalence in our community can be explained by the heroin and opioid epidemic in the Long Island area [12]. Intravenous drug use is a great risk factor for HCV, and although only 15.6% of individuals with anti-HCV had a history of IV drug use, our study was limited since this was a retrospective study and patients are not extensively screened for drug use during routine history taking, and the patient usually volunteers this information to their providers.…”

Screening for Hepatitis C Virus: How Universal Is Universal?

“…10 These young adults with HCV posed many public health challenges that became increasingly apparent: they usually did not access health care until an actual overdose occurred or when seeking treatment for their addiction; these young adults included women of childbearing age, who were now delivering a whole birth cohort of infants exposed to HCV; and based on their age, they were screened based on their risk factors, which was already known to miss cases. 14 , 15 To address some of the shortcomings of the existing screening recommendations, some states severely affected (eg, Kentucky) passed their own laws requiring universal HCV screening for pregnant women. 16…”