PhD student Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida Gainesville, United States
Background: Hepatitis C virus (HCV) infection is markedly increasing in the U.S., but due to its asymptomatic nature, half of HCV-infected people are unaware of their infection. Persistent gaps across the HCV cascade of care have been identified despite current availability of effective direct-acting antivirals (DAA). HCV screening of adults (regardless of risk factors) at emergency departments (EDs) has been proposed as a strategy to end the epidemic, but outcome data for this strategy are lacking.
Objectives: To characterize the cascade of care in individuals screened for HCV at emergency departments in the University of Florida Health system (UFH; Jacksonville and Gainesville, Florida).
Methods: We conducted a retrospective cohort study using electronic health records data (2015-2020). We included adults ≥ 18 years visiting the EDs of UFH during the study period. We identified individuals screened at EDs using Current Procedural Terminology codes, then obtained the proportions of individuals completing each of the following steps of the HCV cascade of care: 1) ED screening, 2) HCV positive antibody testing, 3) HCV positive RNA testing, and 4) first appointment for HCV infection. These proportions were calculated by dividing the number of individuals completing each step (numerator) by the number of individuals completing the previous step (denominator) of the HCV cascade of care.
Results: We identified 212,676 unique individuals (mean SD age=44.382 16.97 years, 53.88% women, 59.25% White and 36.71% Black) eligible for HCV infection screening. Among eligible individuals, 1.18% (n=2,517) were screened for HCV, and of them, 10,57% (n= 266) had a positive HCV antibody test result. Among individuals with a positive HCV antibody test result, 36.84% (n=98) were confirmed to have HCV infection (positive HCV RNA), however, only 13.27% (n=599) of individuals confirmed to have HCV infection attended a first appointment for HCV (linkage to care).
Conclusions: HCV screening at ED visits and subsequent linkage to care are low at UFH. Continued efforts to improve access to care (including access to DAAs) for individuals with HCV are needed.
