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Integrated HCV testing model successfully increases linkage to care
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Researchers from the National Nursing Centers Consortium and Philadelphia Department of Public Health successfully implemented a routine hepatitis C virus infection testing model that increased testing and linkage-to-care among at-risk populations.
“This integrated routine HCV testing model provides a successful example of scaling up HCV testing and linkage-to-care,” Catelyn Coyle, MPH, Med, of the National Nursing Centers Consortium, Philadelphia, and colleagues wrote. “Through the model, a large number of HCV-positive patients were identified, made aware of their current HCV status and linked to care.”
According to the researchers, HCV is the most common blood-borne virus in the U.S. However, routine testing is not common. To determine the impact of an integrated HCV testing routine on patient care, the National Nursing Centers Consortium — a Pennsylvania-based national organization that promotes nurse-led care — implemented a routine opt-out HCV testing and linkage-to-care model at five health centers in Philadelphia between 2012 and 2014 that serve at-risk populations, including the homeless and underserved.
The National Nursing Centers Consortium integrated testing and linkage-to-care by modifying the electronic medical records and clinic policies by increasing staff awareness of HCV testing recommendations. Prior to testing implementation, the nursing consortium educated health center staff on HCV etiology and epidemiology, negotiated with commercial laboratories paid with grant funding for pricing of HCV testing performed on uninsured patients and decided whether universal or at-risk HCV testing was the most efficient testing method. The health centers serving patients at high-risk for HCV performed universal testing and health centers serving low-risk patients performed testing on at-risk individuals.
Throughout the study period, health center staff performed 4,207 anti-HCV tests; 11.6% were anti-HCV-positive (n = 488) and 7.4% were HCV RNA-positive (n = 313). Of the patients with current infection, 77.6% received their HCV RNA-positive results (n = 243) and 58.8% were referred to an HCV care provider (n = 184) then 38.7% were linked to care (n = 121).
The health centers that performed universal testing conducted more HCV tests compared with the other health centers. Staff found the highest rates of current infection in non-Hispanic white patients (18.1%); patients seen at the Public Health Management Corporation Care Clinic, which treats HIV and HCV patients onsite (14.3%); and patients aged 50 to 69 years (10.7%).
Researchers collected data for this study through June 2015; however, analysis continued through August 2015. During this period, the number of anti-HCV-positive patients who received confirmatory HCV testing increased from 88.7% to 92.4%. In addition, researchers identified another 17 patients as currently infected and of these 330 patients with HCV, 92.7% were told about their results (n = 306), 79.4% of these were then referred to an HCV provider (n = 262) and 66.7% received a medical evaluation (n = 220). When the researchers compared the linkage-to-care cascades during data collection with the end of data analysis, they observed an improvement in linkage-to-care rates.
At the International Liver Congress in April, the research performed by Coyle and colleagues was recognized by WHO at an awards ceremony and symposium regarding hepatitis testing. This study was one of five awarded for its innovative hepatitis testing model.
“It is important to understand and share innovative testing approaches such as these, to encourage the prevalence of effective hepatitis testing in more countries around the world,” Massimo Colombo, MD, professor of gastroenterology, University of Milan, Italy, and EASL specialist associated with the competition, said in a press release from WHO.
WHO will include the studies in its 2016 hepatitis testing guidelines to be released in July.
Coyle and colleagues concluded: “Our model successfully integrated HCV testing into routine primary care and showed that a multipronged approach to HCV care can increase testing and improve linkage-to-care rates.” – by Melinda Stevens
Disclosure: Coyle is a medical advisory member for Gilead Sciences.
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