Enhancing Routine Screening and Care Linkage for Hepatitis C Virus in An Urban Safety-Net Health System
Main Article Content
Keywords
hepatitis C, patient navigation, universal screening
Abstract
Hepatitis C virus (HCV) remains a significant public health concern globally. This study aims to evaluate an HCV screening and linkage-to-care program within an urban safety-net health system.
Methods: The program, implemented universal HCV screening across emergency department, inpatient, and outpatient settings, coupled with patient navigation services for positive cases. Data were collected , including patient demographics, risk factors, and outcomes such as screening numbers, test results, new diagnoses, navigation eligibility, and appointment attendance rates. Outcomes were also assessed based on patient knowledge of their infection.
Results: Among 21,018 individuals screened, 6% (1318/21,018) tested positive for HCV antibody, with 68% (878/1293) confirming positive HCV RNA results. Demographically, 68% were born between 1945-1965, 68% were male, and 65% were Black. Of those diagnosed, 55% were new cases, with risk factors including drug use (53%), unemployment (30%), and prior incarceration (21%). Among navigation-eligible patients (64%), 50% accessed imaging services, and 72% attended their initial medical appointment post-imaging.
Conclusion: Patient navigation significantly contributed to successful care linkage, yet ongoing financial sustainability for navigation services remains a challenge
References
1. Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013-2016. Hepatology. 2019;69(3):1020-1031. [PMC free article] [PubMed] [CrossRef]
2. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2016. US Department of Health and Human Services, CDC; 2017. Available at: https://www.cdc.gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdf. Accessed May 23, 2019.
3. Patel RC, Vellozzi C, Smith BD, et al. Results of hepatitis C birth-cohort testing and linkage to care in selected U.S. sites, 2012-2014. Public Health Rep. 2016;131(suppl 2):12-19. [PMC free article] [PubMed] [CrossRef]
4. Geboy AG, Mahajan S, Daly AP, et al. High hepatitis C infection rate among baby boomers in an urban primary care clinic: results from the HepTLC Initiative. Public Health Rep. 2016;131(suppl 2):49-56. [PMC free article] [PubMed] [CrossRef]
5. Taylor BS, Hanson JT, Veerapaneni P, Villarreal R, Fiebelkorn K, Turner BJ. Hospital-based hepatitis C screening of baby boomers in a majority Hispanic South Texas cohort: successes and barriers to implementation. Public Health Rep. 2016;131(suppl 2):74-83. [PMC free article] [PubMed] [CrossRef]
6. Miller LS, Rollin F, Fluker SA, et al. High-yield birth-cohort hepatitis C virus screening and linkage to care among underserved African Americans, Atlanta, Georgia, 2012-2013. Public Health Rep. 2016;131(suppl 2):84-90. [PMC free article] [PubMed] [CrossRef]
7. Castrejón M, Chew KW, Javanbakht M, Humphries R, Saab S, Klausner JD. Implementation of a large system-wide hepatitis C virus screening and linkage to care program for baby boomers. Open Forum Infect Dis. 2017;4(3):ofx109. [PMC free article] [PubMed] [CrossRef]
8. Turner BJ, Taylor BS, Hanson JT, et al. Implementing hospital-based baby boomer hepatitis C virus screening and linkage to care: strategies, results, and costs. J Hosp Med. 2015;10(8):510-516. [PubMed] [CrossRef]
9. Bourgi K, Brar I, Baker-Genaw K. Health disparities in hepatitis C screening and linkage to care at an integrated health system in southeast Michigan. PLoS One. 2016;11(8):e0161241. [PMC free article] [PubMed] [CrossRef]
10. Galbraith JW, Franco RA, Donnelly JP, et al. Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology. 2015;61(3):776-782. [PubMed] [CrossRef]
11. Seña AC, Willis SJ, Hilton A, et al. Efforts at the frontlines: implementing a hepatitis C testing and linkage-to-care program at the local public health level. Public Health Rep. 2016;131(suppl 2):57-64. [PMC free article] [PubMed] [CrossRef]
12. Ramirez G, Cabral R, Patterson M, et al. Early identification and linkage to care for people with chronic HBV and HCV infection: the HepTLC Initiative. Public Health Rep. 2016;131(suppl 2):5-11. [PMC free article] [PubMed] [CrossRef]
13. Schoenbachler BT, Smith BD, Seña AC, et al. Hepatitis C virus testing and linkage to care in North Carolina and South Carolina jails, 2012-2014. Public Health Rep. 2016;131(suppl 2):98-104. [PMC free article] [PubMed] [CrossRef]
14. Coyle C, Viner K, Hughes E, et al. Identification and linkage to care of HCV-infected persons in five health centers—Philadelphia, Pennsylvania, 2012-2014. MMWR Morb Mortal Wkly Rep. 2015;64(17):459-463. [PMC free article] [PubMed]
15. Trooskin SB, Poceta J, Towey CM, et al. Results from a geographically focused, community-based HCV screening, linkage-to-care and patient navigation program. J Gen Intern Med. 2015;30(7):950-957. [PMC free article] [PubMed] [CrossRef]
16. US Preventive Services Task Force. Owens DK, Davidson KW, et al. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;323(10):970-975. [PubMed] [CrossRef]
17. Chicago Department of Public Health. 2019 HIV/STI Surveillance Report. City of Chicago; 2019.
18. Rushovich TA, Arwady A, Salisbury-Afshar E, et al. Annual Opioid Surveillance Report—Chicago 2017. City of Chicago, Office of Epidemiology and Research; 2018. Available at: https://www.chicago.gov/content/dam/city/depts/cdph/CDPH/Healthy%20Chicago/ChicagoOpioidReport2018.pdf. Accessed August 10, 2020.
19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. [PMC free article] [PubMed] [CrossRef]
20. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. [PMC free article] [PubMed] [CrossRef]
21. Hirschtick J, Benjamins M, Homan S. Sinai Community Health Survey 2.0, Chicago, Illinois, 2015-2016. Inter-university Consortium for Political and Social Research; 2018. Available at: https://www.icpsr.umich.edu/web/DSDR/studies/37073/version/1. Accessed August 10, 2020.
22. Sinai Health System. Community Health Needs Assessment Mount Sinai Hospital & Sinai Children’s Hospital. Sinai Health System; June 2016. Available at: https://www.sinai.org/sites/default/files/MSH%20CHNA_Final.pdf. Accessed August 14, 2020.
23. Hunter D. Illinois Medicaid finally to provide life-saving medication to cure hepatitis C [press release]. Chicago: Legal Council for Health Justice; November 8, 2018. Available at: https://legalcouncil.org/illinois-medicaid-hepatitis-c-cure. Accessed August 10, 2020.
2. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2016. US Department of Health and Human Services, CDC; 2017. Available at: https://www.cdc.gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdf. Accessed May 23, 2019.
3. Patel RC, Vellozzi C, Smith BD, et al. Results of hepatitis C birth-cohort testing and linkage to care in selected U.S. sites, 2012-2014. Public Health Rep. 2016;131(suppl 2):12-19. [PMC free article] [PubMed] [CrossRef]
4. Geboy AG, Mahajan S, Daly AP, et al. High hepatitis C infection rate among baby boomers in an urban primary care clinic: results from the HepTLC Initiative. Public Health Rep. 2016;131(suppl 2):49-56. [PMC free article] [PubMed] [CrossRef]
5. Taylor BS, Hanson JT, Veerapaneni P, Villarreal R, Fiebelkorn K, Turner BJ. Hospital-based hepatitis C screening of baby boomers in a majority Hispanic South Texas cohort: successes and barriers to implementation. Public Health Rep. 2016;131(suppl 2):74-83. [PMC free article] [PubMed] [CrossRef]
6. Miller LS, Rollin F, Fluker SA, et al. High-yield birth-cohort hepatitis C virus screening and linkage to care among underserved African Americans, Atlanta, Georgia, 2012-2013. Public Health Rep. 2016;131(suppl 2):84-90. [PMC free article] [PubMed] [CrossRef]
7. Castrejón M, Chew KW, Javanbakht M, Humphries R, Saab S, Klausner JD. Implementation of a large system-wide hepatitis C virus screening and linkage to care program for baby boomers. Open Forum Infect Dis. 2017;4(3):ofx109. [PMC free article] [PubMed] [CrossRef]
8. Turner BJ, Taylor BS, Hanson JT, et al. Implementing hospital-based baby boomer hepatitis C virus screening and linkage to care: strategies, results, and costs. J Hosp Med. 2015;10(8):510-516. [PubMed] [CrossRef]
9. Bourgi K, Brar I, Baker-Genaw K. Health disparities in hepatitis C screening and linkage to care at an integrated health system in southeast Michigan. PLoS One. 2016;11(8):e0161241. [PMC free article] [PubMed] [CrossRef]
10. Galbraith JW, Franco RA, Donnelly JP, et al. Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology. 2015;61(3):776-782. [PubMed] [CrossRef]
11. Seña AC, Willis SJ, Hilton A, et al. Efforts at the frontlines: implementing a hepatitis C testing and linkage-to-care program at the local public health level. Public Health Rep. 2016;131(suppl 2):57-64. [PMC free article] [PubMed] [CrossRef]
12. Ramirez G, Cabral R, Patterson M, et al. Early identification and linkage to care for people with chronic HBV and HCV infection: the HepTLC Initiative. Public Health Rep. 2016;131(suppl 2):5-11. [PMC free article] [PubMed] [CrossRef]
13. Schoenbachler BT, Smith BD, Seña AC, et al. Hepatitis C virus testing and linkage to care in North Carolina and South Carolina jails, 2012-2014. Public Health Rep. 2016;131(suppl 2):98-104. [PMC free article] [PubMed] [CrossRef]
14. Coyle C, Viner K, Hughes E, et al. Identification and linkage to care of HCV-infected persons in five health centers—Philadelphia, Pennsylvania, 2012-2014. MMWR Morb Mortal Wkly Rep. 2015;64(17):459-463. [PMC free article] [PubMed]
15. Trooskin SB, Poceta J, Towey CM, et al. Results from a geographically focused, community-based HCV screening, linkage-to-care and patient navigation program. J Gen Intern Med. 2015;30(7):950-957. [PMC free article] [PubMed] [CrossRef]
16. US Preventive Services Task Force. Owens DK, Davidson KW, et al. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;323(10):970-975. [PubMed] [CrossRef]
17. Chicago Department of Public Health. 2019 HIV/STI Surveillance Report. City of Chicago; 2019.
18. Rushovich TA, Arwady A, Salisbury-Afshar E, et al. Annual Opioid Surveillance Report—Chicago 2017. City of Chicago, Office of Epidemiology and Research; 2018. Available at: https://www.chicago.gov/content/dam/city/depts/cdph/CDPH/Healthy%20Chicago/ChicagoOpioidReport2018.pdf. Accessed August 10, 2020.
19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. [PMC free article] [PubMed] [CrossRef]
20. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. [PMC free article] [PubMed] [CrossRef]
21. Hirschtick J, Benjamins M, Homan S. Sinai Community Health Survey 2.0, Chicago, Illinois, 2015-2016. Inter-university Consortium for Political and Social Research; 2018. Available at: https://www.icpsr.umich.edu/web/DSDR/studies/37073/version/1. Accessed August 10, 2020.
22. Sinai Health System. Community Health Needs Assessment Mount Sinai Hospital & Sinai Children’s Hospital. Sinai Health System; June 2016. Available at: https://www.sinai.org/sites/default/files/MSH%20CHNA_Final.pdf. Accessed August 14, 2020.
23. Hunter D. Illinois Medicaid finally to provide life-saving medication to cure hepatitis C [press release]. Chicago: Legal Council for Health Justice; November 8, 2018. Available at: https://legalcouncil.org/illinois-medicaid-hepatitis-c-cure. Accessed August 10, 2020.
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Published
Dec 26, 2022
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How to Cite
Mohammed Abdullah Morshed Alfawzan, Ahmad Abdulaziz Fahad Alassaf, Mansour Mohammed Ibrahim Altamimi, Hussain Ali Khulaif Alharbi, Nasser Saud Nasser Alshammari, Farhan Mansour Farhan Aldghmani, Farhan Khalaf Munahi Alunazi. (2022). Enhancing Routine Screening and Care Linkage for Hepatitis C Virus in An Urban Safety-Net Health System. Journal of Population Therapeutics and Clinical Pharmacology, 29(03), 557-561. https://doi.org/10.53555/jptcp.v29i03.5423
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Mohammed Abdullah Morshed Alfawzan, Ahmad Abdulaziz Fahad Alassaf, Mansour Mohammed Ibrahim Altamimi, Hussain Ali Khulaif Alharbi, Nasser Saud Nasser Alshammari, Farhan Mansour Farhan Aldghmani, Farhan Khalaf Munahi Alunazi. (2022). Enhancing Routine Screening and Care Linkage for Hepatitis C Virus in An Urban Safety-Net Health System. Journal of Population Therapeutics and Clinical Pharmacology, 29(03), 557-561. https://doi.org/10.53555/jptcp.v29i03.5423