(199) The Care Cascade of Hepatitis C Virus in The Direct-Acting Antiviral Era: A Systematic Review and Meta-Analysis

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 873

Presenting Author(s)

Pilar Hernandez-Con
– University of Florida Department of Pharmaceutical Outcomes and Policy, Gainesville, Florida, United States

Co-Author(s)

Hyun Jin Song
– University of Florida College of Pharmacy, Gainesville, FL, United States
Ikenna Unigwe
– University of Florida College of Pharmacy, Gainesville, Florida, United States
Munaza Riaz
– Student, University of Florida, Gainesville, FL, United States
Natalie Ourhaan
– University of Florida College of Pharmacy, United States
Xinyi Jiang, PhD
– Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, United States
Debbie Wilson, PhD, RN
– Affiliate Clinical Assistant Professor, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
Amanda Joseph
– University of Florida, FL, United States
Haesuk Park
– University of Florida, University of Florida, Gainesville, Florida, United States

Background: The World Health Organization (WHO) has set a target of 80% cure of hepatitis C virus (HCV) by 2030 to achieve the goal of HCV elimination. Despite multiple efforts to improve screening and linkage to care, persistent gaps in the HCV care cascade have been identified in the published literature.

Objectives: We conducted a systematic review and meta-analysis integrating published data to characterize and summarize estimates of the HCV cascade of care in emergency departments (ED) and ambulatory care settings [i.e., HCV antibody (Ab) screening, HCV RNA testing, contact and referral to a specialty provider, treatment initiation and completion, and sustained virologic response (SVR)].

Methods: We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and PsycINFO for articles examining the cascade of HCV care (e.g., in ED or ambulatory care settings) published between January 2014 and March 2021. We excluded non-English articles, systematic reviews, case studies, or studies conducted in non-developed countries. We performed generalized linear mixed models for meta-analyses of seven steps of HCV care cascade to estimate pooled prevalence estimates with 95% confidence intervals (CIs) using Hartung-Knapp adjustment and logit transformation.

Results: Among 100,078 articles screened, we identified 41 articles focusing on ED (n=11) and ambulatory care settings (n=31). Of 84,637 individuals visiting the ED, 38.2% (95%CI 12.7% - 72.4%) were screened for HCV infection. Of those with a positive Ab test, 51.4% had a positive HCV RNA test, 32.6% had a successful contact rate, 16.6% were linked to care, 14.1% initiated treatment and 4.7% achieved SVR. The screening rate for HCV infection was 71.4% (95% CI 27.4% - 94.3%) among 618,443 individuals visiting an ambulatory care setting. Of those with a positive Ab test, 54.9% had a positive HCV RNA test, 47.1% had a successful contact rate, 37.7% were linked to care, 19.8% were prescribed treatment, 15.1% completed treatment and 13.1% achieved SVR.

Conclusions: Compared to ambulatory care settings, screening for HCV infection, successful contact, and linkage to care rates were decreased by up to 50% that subsequently resulted in a lower SVR rate in ED settings. Efforts in improving the HCV care cascade in individuals visiting ED settings are critical to achieving WHO’s HCV elimination goal.