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Urban clinic sites link more than two-thirds of patients with HCV to care

More than two-thirds of patients with hepatitis C who visited a Federally Qualified Health Center in Philadelphia were linked to care, including both antibody and RNA testing, and many continued to medical evaluation, according to a study published in Hepatology.

“Scaling up treatment services in settings where HCV testing is offered may help to improve the HCV care continuum,” Catelyn Coyle, MPH, MEd, from the Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “Expanding the capacity of primary care providers to treat is feasible given the simplicity of treatment and the availability of supportive resources during training and treatment.”

Between Oct. 1, 2012, and June 30, 2016, a total of 25,853 patients with HCV visited one of the five Federally Qualified Health Centers (FQHCs) in Philadelphia that are a run by the National Nurse-Led Care Consortium’s Public Health Management Corporation (PHMC).

During this period, 57.2% received HCV antibody testing, 8.9% of whom tested positive. Results from follow-up RNA testing in 96.1% of those with positive antibody tests revealed 885 patients with chronic infection. Of those, 92.2% received their positive RNA test results, 82.7% were referred to an HCV provider, and 69.4% underwent medical evaluation.

Among those who were linked to a medical evaluation, 55.3% underwent liver disease staging, 15% initiated treatment, 12% completed treatment, 8.7% were assessed for sustained virologic response, and 8% achieved SVR.

“Although we found that almost 70% of patients with chronic HCV infection were seen by an HCV provider and over one-half of these patients underwent liver disease staging, treatment uptake remained low,” the researchers wrote. They noted, however, that “when patients did complete treatment, 94% of those assessed were cured, highlighting the importance of linking HCV-infected patients to appropriate treatment.”

Patients with chronic infection who visited the PHMC Care Clinic test and treat site were significantly more likely to be medically evaluated than those who visited one of the other four FQHC clinics in both the ‘baby boomer’ 1945 to 1965 age group (adjusted OR =2.76; 95% CI, 1.82-4.17) and other ages (aOR = 1.76; 95% CI, 1.17-2.62).

Patients from the PHMC Care Clinic sites were also more likely to undergo liver disease staging after a medical evaluation compared with the other four sites (aOR = 1.92; 95% CI, 1.02-2.86).

“We demonstrated significant differences in successful patient navigation through steps of the HCV care continuum by clinic. One possible explanation is that more than four years of data may be required to determine whether this is an anomaly or whether such a trend would hold. Another possible reason for these findings could be missing data primarily from the FQHCs that had to refer patients offsite for treatment,” Coyle and colleagues wrote. “Despite this finding, our results overall suggest that building the capacity of primary care providers to treat HCV infection in a setting where routine HCV testing has been implemented can substantially improve the HCV care continuum.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.