Trends in HCV RNA Testing Among HCV Antibody-Positive Persons in Care, 2003-2010

Spradling, Philip R.; Tong, Xin; Rupp, Loralee B; Moorman, Anne C.; Lü, Mei; Teshale, Eyasu H.; Gordon, Stuart C.; Vijayadeva, Vinutha; Boscarino, Joseph A.; Schmidt, Mark; Holmberg, Scott D.; Nerenz, David R.; Lamerato, Lois; Akkerman, Nonna; Oja–Tebbe, Nancy; Cogan, Chad; Larkin, Dana; Daar, Zahra; Leader, Joe B.; Smith, Robert E.; Sylva, Kelly E; Parker, John V.; Schmidt, M; Donald, Judy; Keast, Erin

doi:10.1093/cid/ciu509

Cited by 29 publications

(23 citation statements)

References 6 publications

(8 reference statements)

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“…Although, HCV RNA and genotype testing rates have improved in recent years and are similar to those reported for HCV positive Veterans and Kaiser Permanente members in the United States (95%) and higher than for primary care in Canada and United States (47.0% to 60.9%), there is a further need to reduce the gap between those antibody diagnosed and those undergoing further testing (Maier et al, 2016, Jonas et al, 2016, Spradling et al, 2014, Viner et al, 2015). We demonstrated that people with high risk activities progress to RNA testing while men and older cohorts, especially those born in 1945–64 lacked RNA testing (Spradling et al, 2014, Cachay et al, 2014).…”

Section: Discussionmentioning

confidence: 69%

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The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

Janjua

Kuo

et al. 2016

EBioMedicine

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BackgroundPopulation-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakage at each stage.MethodsThe BC Hepatitis Testers Cohort (BC-HTC) includes 1.5 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV cascade of care stages: 1) estimated population prevalence; 2) HCV diagnosed; 3) HCV RNA tested; 4) genotyped; 5) initiated treatment; and 6) achieved sustained virologic response (SVR).ResultsWe estimated that 73,203 people were HCV antibody positive in BC in 2012 (undiagnosed: 18,301, 25%; diagnosed: 54,902, 75%). Of these, 56%(40,656) had HCV RNA testing; 34%(26,300) were genotyped; 12%( 8532 ) had received interferon-based therapy and 7%(5197) had SVR. Males, older birth cohorts, and HBV coinfected were less likely to undergo HCV RNA testing. Among those with chronic HCV infection, 32% had received liver-related care. Retention in liver care was more likely in those with HIV, cirrhosis, and drug/alcohol use and less likely in males and HBV coinfected.ConclusionsAlthough there are gaps in HCV RNA testing and genotyping after HCV diagnosis, the major gap in the cascade of care was low treatment initiation. People with comorbidities progressed through the cascade of testing and care but few received treatment.

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Section: Discussionmentioning

confidence: 69%

“…We demonstrated that people with high risk activities progress to RNA testing while men and older cohorts, especially those born in 1945–64 lacked RNA testing (Spradling et al, 2014, Cachay et al, 2014). A major factor for lack of genotyping among those RNA tested was history of drug use.…”

Section: Discussionmentioning

confidence: 88%

The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

Janjua

Kuo

et al. 2016

EBioMedicine

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“…Other studies of PWID sampled from cities in the United States have reported markedly lower proportions of individuals undergoing medical evaluation following HCV+ serotesting, typically in the range of 21% (Mehta et al, 2008) to 27% (Strathdee et al, 2005), although few researchers have specifically examined the initial step of medical follow-up (i.e., contacting a healthcare provider to make an appointment). These proportions contrast with studies of HCV-seropositive individuals receiving medical evaluation in other settings: for instance, 75% of Australian PWID receiving OST (Treloar, Hull, Dore, & Grebely, 2012) and 57% of a U.S. clinic-based sample (Spradling et al, 2014). Another study of 245 seropositive patients from the New York City health department reported that 67% obtained RNA testing when referred directly to medical services after T&C (McGibbon, Bornschlegel, & Balter, 2013), whereas 53% of PWID received medical evaluation in data reported by Grebely and colleagues (2010) when healthcare referral was offered reflexively after T&C. In the latter study, clinical criteria based on published guidelines emerged as the primary determinant of HCV treatment initiation (Grebely et al, 2010).…”

Section: Discussionmentioning

confidence: 71%

“…The virus is hyper-endemic worldwide among people who inject drugs (PWID), with 73% median seroprevalence among individuals who have ever injected and transmission typically occurring via sharing of needles, syringes, and drug-preparation equipment (Nelson et al, 2011). Unfortunately, medical evaluation to assess for disease progression and treatment eligibility occurs sporadically among seropositive individuals in the general population (Spradling et al, 2014) and even less frequently among PWID (Wiessing et al, 2014). Fortunately, remarkable advances in pharmacotherapy now offer greater than 90% efficacy for most genotypes, tremendously decreased adverse effect profiles, and shortened interferon- and ribavirin-free regimens (Li & De Clercq, 2017; Rehermann, 2016), and it has been shown that PWID in community clinics and opioid substitution programs can achieve rates of sustained virologic response (SVR) equivalent to non-injectors even with older regimens including interferon and ribavirin (Grebely et al, 2016; Grebely et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs

Stephens

Young

Havens

2017

International Journal of Drug Policy

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Background Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods 503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results 150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. Conclusion While only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.

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“…20,22 However, studies show that 24%–39% of patients do not receive HCV RNA testing after an anti-HCV+ test result. 22–25 Moreover, HCV/HIV co-infection is associated with greater odds of receiving high-quality care (e.g., receipt of HCV RNA testing for diagnosis of HCV viremia) than HCV infection alone. 22 A post hoc cross-sectional analysis was performed to examine HIV infection status as an independent predictor of receiving HCV RNA testing among primary care outpatients with an anti-HCV+ test result.…”

Section: Introductionmentioning

confidence: 99%

HIV Infection Status as a Predictor of Hepatitis C Virus RNA Testing in Primary Care

Yartel

Rein

Brown

et al. 2015

American Journal of Preventive Medicine

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Introduction Receipt of hepatitis C virus (HCV) RNA testing following a positive HCV antibody (anti-HCV+) test result to establish current infection is a quality indicator for HCV-related care. This study examines HIV infection status as a predictor of HCV RNA test receipt after an anti-HCV+ result in the primary care setting. Methods Electronic medical records of anti-HCV+ patients from a multisite retrospective study of patients aged ≥18 years who utilized one or more primary care outpatient services during 2005–2010 were analyzed in 2014. A multivariable logistic regression model examined the independent relationships between patient characteristics and receipt of HCV RNA testing. Results Among 1,115 anti-HCV+ patients, 133 (11.9%) were also HIV-positive. Of these, 77.4% (n=103) underwent HCV RNA testing to determine current infection status. By contrast, 66.7% (n=654/980) of anti-HCV+ patients who were HIV-negative received HCV RNA testing. Following multivariable adjustment, the odds of receiving HCV RNA testing were higher among anti-HCV+ patients who were also HIV-positive (AOR=1.9, 95% CI=1.2, 3.0), compared with their HIV-negative counterparts. Elevated alanine aminotransferase level was also associated with receipt of HCV RNA testing (AOR=1.9, 95% CI=1.4, 2.4). Black race was associated with decreased odds of receiving HCV RNA testing (AOR=0.7, 95% CI=0.5, 1.0). Conclusions HIV infection status is independently associated with the likelihood of receiving HCV RNA testing following an anti-HCV+ result. One quarter of anti-HCV+ patients who were also HIV-positive and one third of their HIV-negative counterparts, respectively, did not receive testing to establish active HCV infection, which is imperative for appropriate care and treatment.

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Trends in HCV RNA Testing Among HCV Antibody-Positive Persons in Care, 2003-2010

Abstract: Less than two-thirds of persons with a positive HCV antibody test had a follow-up RNA test. Rapid ascertainment of HCV infection status with reflex testing to RNA is critical to identify persons eligible for treatment.

Cited by 29 publications

References 6 publications

The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs

HIV Infection Status as a Predictor of Hepatitis C Virus RNA Testing in Primary Care

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