By screening people eligible for hepatitis C testing and providing follow-up support in a community emergency department, researchers found that linkage to care for those testing positive exceeded 90 percent, according to study results published in the Journal of Viral Hepatitis.
“There is a need for a community outreach and partnership model where activities targeting screening in the community are combined with an organization that can provide direct linkage of care for the target community,” Steve Kwon, MD, MPH, of the Holy Name Medical Center in New Jersey, and colleagues concluded.
An estimated 2.4 million people are living with hepatitis C virus (HCV) in the United States. Baby boomers, meaning people born between 1945 and 1965, make up almost three quarters of people with HCV. Left untreated, chronic hepatitis C can lead to serious complications including cirrhosis and liver cancer.
While hepatitis C treatment is highly effective nowadays, early detection and access to medical care are critical to reducing morbidity and mortality. Including HCV testing prompts within electronic health records could improve testing standards. For people without easy access to primary care, emergency department visits are an important avenue of HCV screening. But few studies have analyzed the effect of HCV screening during emergency visits outside large urban centers.
Kwon and colleagues carried out HCV screening for baby boomers at a community hospital emergency department in New Jersey, from February 2016 to December 2018. Using a screening algorithm, the team integrated HCV testing eligibility into the electronic medical record system. Individuals eligible for testing were identified, connected to laboratory resources, informed of their results and followed for linkage to care. The researchers tracked the participants’ ability to access medical care.
A total of 14,927 baby boomers were evaluated; the average age was 57 years. Of those who were deemed eligible for HCV testing, 555 individuals (3.7 percent) tested positive for hepatitis C antibodies, meaning they had been exposed to the virus, and 147 people (1.0 percent) tested positive for HCV RNA, meaning they had active infection and could potentially benefit from treatment. This implies that only 27 percent of those who had antibodies against HCV were chronically infected.
Men, Black people and those born in the United States were more likely to have antibodies against HCV. Of the 6,932 white individuals who were screened, 293 (4.2 percent) tested positive on an HCV antibody test, with 82 (28 percent) of those testing positive for HCV RNA. Of the 1,960 Black people who were screened, 112 (5.7 percent) were positive for HCV antibodies, with 46 (41 percent) also testing positive for HCV RNA.
At the outset, only 18 percent of people had been able to access medical care. This grew to more than 94 percent after increased support through the patient navigation model of healthcare.
“There is a need for a HCV screening protocol in the community to reduce the number of undiagnosed individuals, decrease the number of those who are diagnosed late and ensure strong linkages to care,” wrote the researchers.
Click here to read the study abstract in the Journal of Viral Hepatitis.
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