1070 - Risk factors for failed linkage to Hepatitis C care

Background: Many patients with Hepatitis C (HCV) who are referred to HCV care do not attend their HCV clinic appointments. As social determinants of health are known to affect HCV acquisition, we sought to evaluate their role on successful linkage to HCV care also.

Methods: A retrospective chart review was conducted on patients with both a positive HCV antibody or RNA test and a scheduled but not-attended infectious disease (ID) clinic appointment in 2017. Abstracted data included patient demographic, type of insurance, HCV test results, and risk factors that may impair outpatient HCV linkage. Descriptive statistics, chi-square, and Fisher exact tests were performed. We sought to identify the factors limiting patients with HCV from attending their first clinic visit.

Results: There were 161 out of 1539 patients (10%) who did not keep their HCV clinic appointment. The mean age was 48 years, 45% were female, and the majority were African American (61%). Most patients had insurance that was accepted by the HCV clinic (76%) and had been tested for HCV while admitted to the hospital (94%). Almost all patients had been tested both for HCV antibodies (98%) and viral RNA via PCR (97%). Risk factors known to contribute to unsuccessful linkage to care were common: substance use (85%), mental health diagnosis (71%), inadequate transportation (66%), housing insecurity (61%), history of medication nonadherence (61%), and alcohol use (52%). Seven patients (4%) died by the end of 2017. Patients alive at the end of 2017 were more likely to have insurance accepted at the ID clinic compared to those without accepting insurance (98% vs. 90%, p 0.06).

Conclusion: Significant barriers are present among patients with HCV who were not successfully linked to a scheduled HCV appointment. Patients with HCV should be provided additional support as appropriate to address the social determinants of health that may limit their linkage to HCV care. Lack of accepted insurance at the ID clinic was associated with mortality and warrants further investigation into its causes.