(052) Impact of Active Substance Use Disorders on Linkage to Care for Inpatients Testing Positive for Hepatitis C

Abstract:

Background:

Hepatitis C virus infection (HCV) is associated with significant morbidity and mortality in the United States. Recently, management has advanced through introduction of direct acting oral antivirals (DAA), which can cure infection for the majority of patients. Despite this, linkage to care for newly diagnosed inpatients remains low, often due to psychosocial factors (Im 2021, Malespin 2019). Intravenous drug use (IVDU) remains a primary mode of transmission for HCV infection in high income countries, with an increase in HCV incidence during the opioid pandemic (Zibbell 2017). In this study, we sought to characterize changing demographics, substance use, and linkage to care rates for inpatients testing positive for HCV at our tertiary academic medical center between 2015 and 2021.



Methods:

Institutional Review Board approval was granted to conduct a retrospective chart review. We included all individuals 18 and older who presented to Northwestern Memorial Hospital from 1/1/2015 through 5/31/2021 and had an inpatient hepatitis C antibody test ordered. Variables examined included demographics, insurance status, laboratory testing results, and linkage to care as defined by an outpatient appointment with either hepatology or infectious disease. For HCV RNA+ subjects, we reviewed patient charts to obtain information regarding HCV risk factors (including IVDU), linkages to substance use treatment, and initiation of medication-assisted treatment.



Results:

Chart review has been completed and we are currently completing the data analysis stage. Preliminary results from 353 HCV RNA+ subjects indicate a high prevalence of active substance use (42.2%), active IVDU (18.4%), and homelessness (24.9%), with relatively low rates of linkage to both outpatient HCV and substance use treatments. We anticipate being finished with data analysis by July 2022.



Discussion:

Discussion to follow completion of data analysis. We intend to review changing demographics over time as well as factors that may have impeded linkage to HCV care in this population.



Implications:

Inpatient hospitalizations may provide a window of opportunity to engage patients with active substance use disorders and advocate for connection to evidence-based HCV and addiction treatments.



References:



Im DCS et al. Characteristics and specialist linkage to care of patients diagnosed with chronic hepatitis C across different settings in an urban academic hospital: implications for improving diagnosis and linkage to care. Frontiers in Microbiology 2021;12:576357.



Malespin M et al. Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic. Annals of Hepatology 2019;18:304-309.



Zibbell JE et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. AJPH 2018;108(2):175-181.