Introduction: An estimated 2.4 million people in the United States are living with chronic hepatitis C (HCV). Approximately 40% of HCV patients are unaware of their diagnosis. Socioeconomic status and the ongoing opioid crisis are important risk factors for HCV infection. The rates of intravenous and intranasal drug use in California’s Central Valley are among the highest in the nation and many are socioeconomically disadvantaged, creating a perfect scenario for HCV propagation. Identification and treatment of HCV is imperative to prevent morbidity and mortality as well as the spread of infection.
Methods: A universal HCV screening program was implemented in the internal and family medicine teaching clinics at a large federally qualified health center in the Central Valley. The electronic medical record identifies eligible patients based on current CDC guidelines. Once identified, an automatic prompt alerts the provider and HCV labs (HCV antibody test with reflex to genotype and RNA level) are auto-populated and available to be signed at the end of the visit. Patients with active HCV infection (positive RNA level) are contacted by the designed project coordinator, who facilitates linkage to care to a primary care provider as well as to the provider experienced in treating HCV. Linkage to care is defined as, completion of the first medical appointment.
Results: Universal screening was implemented on July 1, 2021. The data here was collected between July 1, 2021 and November 30, 2021. A total of 1152 patients were eligible for screening and 1084 patients completed the screening. Twenty-three patients tested positive for HCV Ab and 11 patients (9 male and 2 female) tested positive for HCV RNA. Most HCV RNA positive patients were Hispanic (36%) and African American (27%). The most common genotype was 1a (45%). Fifty-four percent of HCV RNA positive patients were linked to care.
Discussion: Prior to the implementation of universal screening, only 54% eligible patients were screened in a 12-month period. Based on preliminary data, we screened 94% eligible patients within a 5-month period. In addition, only 31% of HCV patients prior to universal screening were linked to care compared to the 54% linked to care through our initiative. Our project encouraged providersto screen patients which helped identify HCV in the community. Although data collection is ongoing, wesuspect this initiative will surpass the total number of patients screened and linked to care compared to previous practices.
