Public health clinic‐based hepatitis C testing and linkage to care in baltimore

Testing and linkage to care are important determinants of hepatitis C virus (HCV) treatment effectiveness. Public health clinics serve populations at high risk of HCV. We investigated their potential to serve as sites for HCV testing, initiation of and linkage to HCV care. Cross‐sectional study of patients accessing sexually transmitted infection (STI) care at the Baltimore City Health Department (BCHD) STI clinics, from June 2013 through April 2014 was conducted. Logistic regression was used to assess factors associated with HCV infection and specialist linkage to care. Between 24 June 2013 and 15 April 2014, 2681 patients were screened for HCV infection. Overall, 189 (7%) were anti‐HCV positive, of whom 185 (98%) received follow‐up HCV RNA testing, with 155 (84%) testing RNA positive. Of 155 RNA‐positive individuals, 138 (89%) returned to the STI clinic for HCV RNA results and initial HCV care including counselling regarding transmission and harm reduction in alcohol, and 132 (85%) were referred to a specialist for HCV care. With provision of patient navigation services, 81 (52%) attended an offsite HCV specialist appointment. Alcohol use and lack of insurance coverage were associated with lower rates of specialist linkage (OR 0.4 [95% CI 0.1–0.9] and OR 0.4 [95% CI 0.1–0.9], respectively). We identified a high prevalence of HCV infection in BCHD STI clinics. With availability of patient navigation services, a large proportion of HCV‐infected patients linked to off‐site specialist care.

[1]  G. Dore,et al.  Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States , 2015, Annals of Internal Medicine.

[2]  D. Holtzman,et al.  Identification and Linkage to Care of HCV-Infected Persons in Five Health Centers — Philadelphia, Pennsylvania, 2012–2014 , 2015, MMWR. Morbidity and mortality weekly report.

[3]  Caroline C. Johnson,et al.  The continuum of hepatitis C testing and care , 2015, Hepatology.

[4]  C. Umscheid,et al.  The Treatment Cascade for Chronic Hepatitis C Virus Infection in the United States: A Systematic Review and Meta-Analysis , 2014, PloS one.

[5]  Bryce D. Smith,et al.  Hepatitis C virus control among persons who inject drugs requires overcoming barriers to care. , 2013, World journal of gastroenterology.

[6]  J. Ward,et al.  The new paradigm of hepatitis C therapy: integration of oral therapies into best practices , 2013, Journal of viral hepatitis.

[7]  A. Moorman,et al.  Hepatitis C in the United States. , 2013, The New England journal of medicine.

[8]  D. Holtzman,et al.  Hepatitis C virus testing of persons born during 1945-1965: recommendations from the Centers for Disease Control and Prevention. , 2012, Annals of internal medicine.

[9]  J. Arnsten,et al.  Concurrent group treatment for hepatitis C: implementation and outcomes in a methadone maintenance treatment program. , 2012, Journal of substance abuse treatment.

[10]  Rebecca L Morgan,et al.  Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. , 2012, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[11]  M. Denniston,et al.  Awareness of infection, knowledge of hepatitis C, and medical follow‐up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001‐2008 , 2012, Hepatology.

[12]  R. Monina Klevens,et al.  The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007 , 2012, Annals of Internal Medicine.

[13]  J. Albrecht,et al.  Racial differences in hepatitis C treatment eligibility , 2011, Hepatology.

[14]  D. Vlahov,et al.  Changes in blood-borne infection risk among injection drug users. , 2011, The Journal of infectious diseases.

[15]  H. El‐Serag,et al.  Insurance status and treatment candidacy of hepatitis C patients: Analysis of population‐based data from the United States , 2011, Hepatology.

[16]  P. Thuras,et al.  Significant reductions in drinking following brief alcohol treatment provided in a hepatitis C clinic. , 2010, Psychosomatics.

[17]  H. Hutton,et al.  The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients. , 2008, Alcoholism, clinical and experimental research.

[18]  Dongki Lee,et al.  [The incidence rates and risk factor of mild injury for two weeks--using Korea National Health and Nutrition Examination Survey 2001]. , 2008, Journal of preventive medicine and public health = Yebang Uihakhoe chi.

[19]  D. Vlahov,et al.  Limited Uptake of Hepatitis C Treatment Among Injection Drug Users , 2008, Journal of Community Health.

[20]  S. Friedman,et al.  Estimating the Prevalence of Injection Drug Users in the U.S. and in Large U.S. Metropolitan Areas from 1992 to 2002 , 2008, Journal of Urban Health.

[21]  P. Thuluvath,et al.  Racial disparity in liver disease: Biological, cultural, or socioeconomic factors , 2008, Hepatology.

[22]  Robert J Volk,et al.  AUDIT-C as a brief screen for alcohol misuse in primary care. , 2007, Alcoholism, clinical and experimental research.

[23]  C. Rietmeijer,et al.  Integrating Viral Hepatitis Prevention Services into an Urban STD Clinic: Denver, Colorado , 2007, Public health reports.

[24]  R. Zimmerman,et al.  Integrating Viral Hepatitis Prevention into STD Clinics in Illinois (excluding Chicago), 1999–2005 , 2007, Public health reports.

[25]  T. S. Jones,et al.  The Costs and Impacts of Testing for Hepatitis C Virus Antibody in Public STD Clinics , 2007, Public health reports.

[26]  S. Zickmund,et al.  Mental and physical symptoms associated with lower social support for patients with hepatitis C. , 2006, World journal of gastroenterology.

[27]  M. Alter,et al.  The Prevalence of Hepatitis C Virus Infection in the United States, 1999 through 2002 , 2006, Annals of Internal Medicine.

[28]  R. Cook,et al.  Is There an Association Between Alcohol Consumption and Sexually Transmitted Diseases? A Systematic Review , 2005, Sexually transmitted diseases.

[29]  B. Romanowski,et al.  Hepatitis C Seroprevalence and Risk Behaviors in Patients Attending Sexually Transmitted Disease Clinics , 2003, Sexually transmitted diseases.

[30]  H. Margolis,et al.  Screening for Chronic Hepatitis B and C Virus Infections in an Urban Sexually Transmitted Disease Clinic: Rationale for Integrating Services , 2001, Sexually transmitted diseases.

[31]  E L Murphy,et al.  Prevalence of hepatitis C virus infection in the United States. , 1999, The New England journal of medicine.

[32]  P. Marcellin,et al.  Effect of alcohol consumption on serum hepatitis C virus RNA and histological lesions in chronic hepatitis C , 1998, Hepatology.

[33]  J. M. Calvo Romero,et al.  Gastric adenocarcinoma and kidney transplantation , 1998 .

[34]  E. Hook,et al.  Patients Attending STD Clinics in an Evolving Health Care Environment: Demographics, Insurance Coverage, Preferences for STD Services, and STD Morbidity , 1997, Sexually transmitted diseases.

[35]  M. Alter,et al.  Hepatitis C, hepatitis B, and human immunodeficiency virus infections among non-intravenous drug-using patients attending clinics for sexually transmitted diseases. , 1994, The Journal of infectious diseases.

[36]  O. Aasland,et al.  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. , 1993, Addiction.

[37]  D. Chan,et al.  Hepatitis B and hepatitis C in emergency department patients. , 1992, The New England journal of medicine.

[38]  S. Holmberg,et al.  Hepatitis C testing, infection, and linkage to care among racial and ethnic minorities in the United States, 2009-2010. , 2013, American journal of public health.

[39]  V. Preedy,et al.  National Health and Nutrition Examination Survey , 2010 .

[40]  R. Grant,et al.  Barriers to the treatment of hepatitis C. Patient, provider, and system factors. , 2005, Journal of general internal medicine.

[41]  J. Emparanza,et al.  [The prevalence of hepatitis C virus infection]. , 1998, Gastroenterologia y hepatologia.