Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System

Abstract

Context: Birth cohort ("baby boomer") screening represents a well-validated strategy for the identification of asymptomatic hepatitis C-infected patients. However, successful linkage of newly diagnosed patients to antiviral therapy has been more difficult to accomplish. Objective: To analyze the results of a systemwide birth cohort screening program in a US community health care system. Design: We analyzed the data from an ongoing hepatitis C virus (HCV) screening and treatment program that was established at NorthShore University Health System in 2015. Hepatitis C virus screening by primary care providers was prompted through automated Best Practice and Health Maintenance alerts. Patient visits and screening orders were tracked using a customized HCV dashboard. Virologic, demographic, and treatment data were assessed and compared with those of a cohort of patients with previously established HCV infection. Results: Since program inception, 61 8161 (64.3%) of the entire NorthShore baby boomer population of 96 001 patients have completed HCV antibody testing, and 160 patients (0.26%) were antibody positive. Of 152 antibody-positive patients who underwent HCV RNA testing, 53 (34.2%) were viremic. A total of 39 of 53 patients (73.6%) underwent antiviral therapy and achieved a sustained virologic response. Compared with patients identified through screening, a comparison cohort of patients with previously established HCV had more advanced fibrosis and significantly lower dropout rates. The COVID-19 pandemic was associated with a decrease in the number of outpatient visits of screening-eligible patients and with a reduction in HCV screening rates. Conclusion: Our data demonstrate the electronic medical records-assisted systemwide implementation of HCV birth cohort screening and successful linkage to antiviral therapy in a community-based US multihospital system.

Accessing hepatitis C direct acting antivirals among people living with hepatitis C: a qualitative study

“…Given the limitations of a risk-based approach to screening and their own experiences of having no symptoms attributable to hepatitis C, participants described the importance of considering broader population-based screening strategies for identifying asymptomatic individuals otherwise perceived as being at minimal risk for hepatitis C. Notably, through their participation in the focus groups, participants identified older adults as being one potential group that could benefit from enhanced screening programs, an observation that is consistent with birth-cohort screening strategies endorsed as a means of identifying undiagnosed individuals [ 50 , 51 ]. P: There may be a certain age group of people, I don’t know, that might be, I don’t know.…”

Evidence-Based Strategies for Micro-elimination of Chronic Hepatitis B Virus Infection

“…The US Department of Health and Human Services found that from 2013 to 2016, only 32% of chronic HBV carriers were aware of their infection contributing to the underdiagnosis of cirrhosis and HCC [40]. Increased screening efforts for HCV across communities in the USA, including the Northshore University Health System, resulted in successfully screening 64.3% of the eligible population born between 1945 and 1965 [41].…”