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Check Hep C program effective in identifying HCV in New York
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BOSTON — The Check Hep C program, a community-based initiative in New York that focuses on finding and testing individuals with hepatitis C virus infection in high-risk populations, was effective in increasing diagnostic testing and screening of individuals and connecting them with proper services, according to data presented at The Liver Meeting.
“The primary success of the Check Hep C Program model was its effectiveness in identifying, diagnosing and linking high-risk hepatitis C infected persons to care,” researcher Mary M. Ford, of the New York City Department of Health and Mental Hygiene, told Healio.com/Hepatology. “With new HCV medications showing high cure rates and more tolerable side effects, there is an added imperative to diagnose HCV-infected persons and link them to care and treatment.”
Mary M. Ford
The program, which formed after the CDC recommended HCV testing, funded eight organizations from 12 community clinical sites, including federally qualified health centers, syringe exchange programs and these combined facilities, to provide testing in high-risk neighborhoods. The testing procedure consisted of “targeted outreach, point of care rapid antibody testing and, after a positive antibody test, an immediate blood draw for RNA testing,” according to the research.
Between May 2012 and April 2013, 4,751 people were tested, and of these, 880 were positive for HCV antibody. A total of 678 people positive for HCV antibody underwent RNA testing and 76% of them had HCV. Fifteen percent of all baby boomers (n=1,901) were positive for HCV. Hispanics and whites had a higher prevalence of HCV (15% and 14%, respectively) compared with blacks (7%). Twenty-five percent of individuals reported injecting drugs at some point in their lives, with 361 reporting having injected 30 days before testing. Individuals with past injection drug use had the highest risk for HCV (OR=20.6; 95% CI, 16.4-26).
Eighty-five percent of patients with HCV were seen by a physician at their first medical appointment, and as of April, more than 50% were still receiving care, according to the research.
“The screening and diagnosis method was a successful strategy that can not only be used to implement the CDC and US Preventive Services Task Force recommendation and the New York state hepatitis C testing law, but can be replicated in other cities with similar populations,” Ford said. – by Melinda Stevens
For more information:
Ford MM. Abstract #1448. Presented at: The Liver Meeting; Nov. 7-11, 2014; Boston.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Adrian M. Di Bisceglie, MD, FACP
New York State is one of the states that has pushed for mandated hepatitis C screening of baby boomers. This is an example of a group getting together to say, “The state is telling us we have to do this, how do we get it done?-What kind of programs can we put together and what are the results?”
The conclusion is that the program was effective in identifying, diagnosing and linking HCV-positive persons to care. The method of providing HCV RNA testing immediately after antibody-positive test is a successful strategy that can be used to increase rates of complete HCV diagnosis.
One of the challenges is that patients may test positive for antibody to hepatitis C, but that would be because they have resolved their HCV infection. Somewhere between 15% and 40% of patients resolve their infection, so they will remain antibody positive.
To know if somebody is at risk of liver disease and liver disease progression, you have to check to see if they are still viraemic. The usual way [to achieve this] is you do an antibody test and then [if positive] you send a sample for HCV RNA and several weeks later you have a result and try and contact the patient.
In this kind of community screening situation, these are often individuals you may only get one crack at to screen them and to find them being positive [for hepatitis C]. You need to turn around that HCV RNA testing real fast so you can contact the patient, let them know they are infected and link them to care so they can get into the medical system to be evaluated and get treated.
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