Using database linkages to monitor the continuum of care for hepatitis C virus among syringe exchange clients: Experience from a pilot intervention

Abstract

Background Because many people who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) and have poor access to medical care, many HCV-infected PWID remain undiagnosed and unaccounted for in surveillance systems. Syringe exchange programs (SEPs) are an under-utilized resource for collecting information missing from surveillance systems. Partnerships with public health agencies represent a potentially innovative approach to studying the HCV epidemic for PWID. The goal of this study was to characterize the HCV care continuum for a cohort of PWID using database linkages. Methods Data needed to describe the HCV care continuum for 235 PWID were collected from surveillance data provided by the Wisconsin Division of Public Health, a computerized survey administered by SEP staff, and a follow-up interview delivered by academic research staff. When possible, we attempted to confirm each individual’s position in the HCV care continuum with at least 2 of the 3 data sources. Results Participants ranged in age from 18–63 years, 60% self-identified as non-Hispanic white, and 77% were male. Overall, we determined that 208 (89%) of the 235 participants had ever been tested for HCV and 72 (31%) had ever tested positive. Of those 72, 46 (64%) had been linked to care, 14 (19%) received pre-treatment evaluation, and 4 (6%) reported initiating treatment. Confirmation by at least 2 data sources ranged from 14–57% of cases for each stage of HCV care. Conclusion Available data sources show a large degree of variability when used to characterize the HCV care continuum. New strategies to enhance the quality and completeness of these data sources could substantially improve ongoing efforts to monitor the HCV care continuum among PWID.

The continuum of hepatitis C care for criminal justice involved adults in the DAA era: a retrospective cohort study demonstrating limited treatment uptake and inconsistent linkage to community-based care

“…Despite HCV therapeutic advances, challenges remain for HCV screening and linkage to care. Investigations conducted around the US have found that a low proportion of individuals who test positive for HCV are linked to care and few receive treatment (Bourgi et al 2016 ; Hochstatter et al 2017 ; Viner et al 2015 ). Two large population-level studies of HCV in the United States conducted by the CDC, the Chronic Hepatitis Cohort Study (CHeCS) and the National Health and Nutrition Examination Survey (NHANES), demonstrate that 32–38% of those who test positive for HCV antibodies receive follow-up HCV care and 7–11% are treated (Moorman et al 2013 ; Spradling et al 2012 ; Denniston et al 2012 ).…”

“…Routine and/or opt-out testing programs upon intake to prison, coupled with automatic laboratory reporting processes, provide the opportunity to collect information on the HCV epidemic among incarcerated populations. These processes ensure HCV-infected individuals cycling through correctional facilities are accounted for in public health surveillance systems, and thus provide useful tools for evaluating the HCV care continuum for individuals as they transition in and out of the criminal-justice system (Hochstatter et al 2017 ). The overall goal of this study was to characterize the receipt of HCV care and treatment services for a cohort of HCV-infected adults identified in a single state prison system.…”

The Consensus Hepatitis C Cascade of Care: Standardized Reporting to Monitor Progress Toward Elimination

“…However, a unified approach to defining the HCV CoC stages is lacking. Consequently, findings are being reported in highly diverse ways [9][10][11][12][13][14]. A similar situation in the HIV field limits the comparative value of HIV CoCs and makes it difficult to aggregate data for accurate assessments of progress at the regional and global levels [15].…”

A Mobile Health Intervention to Improve Hepatitis C Outcomes Among People With Opioid Use Disorder: Protocol for a Randomized Controlled Trial

“…At the time of the baseline assessment, 93% of HCV RNA–positive individuals reported they had seen a medical provider for HCV, a level substantially higher than what had been reported in prior studies [26,53,54]. Because the survey questions did not specifically ask whether participants saw a provider specifically to discuss starting HCV treatment, our study may overestimate true linkage to HCV care.…”