Sexually Transmitted Diseases Clinic Based Hepatitis C Testing and Linkage to Care
HCV testing and linkage to care directly impact treatment effectiveness. Sexually transmitted disease (STD) clinics serve populations at high risk for HCV. We describe experience with HCV testing and linkage to care at public STD clinics in Baltimore.
Through funding from the Centers for Disease Control Foundation, rapid HCV antibody testing was routinely offered to all STD clinic attendees, age 18-70 years of the Baltimore City Health Department (BCHD) STD clinics starting in June 2013. Patients received HCV antibody posttest counseling including an alcohol use screen followed by a brief intervention at the initial STD clinic encounter. Follow up HCV RNA testing was provided to patients with a positive antibody result. Patients returned 2 weeks later for receipt of HCV RNA results, comprehensive HCV care including education, risk reduction and alcohol counseling, hepatitis B immunization (as indicated) and referral for specialist HCV treatment. Patient navigation services were provided for patients to aid linkage to care.
Between June 24, 2013 and January 31, 2014, 2,204 individuals; median age 29 (IQR 24-41) years, 92% African American, 61% male were screened for hepatitis C. Overall, 142(6.4%) were HCV antibody positive. 108 (76%) of patients were insured; majority through Medicaid (56.5%). All these patients had previously accessed care at the STD clinics. Among 326 patients born between 1945 and 1965 (the CDC “birth cohort”), 28% were HCV antibody positive. Of the 142 HCV positive patients, 98% had confirmatory HCV RNA testing; of which 115 (82.7%) were confirmed to be viremic. Of the 115 HCV RNA positive patients, 80% returned to the STD clinic for initiation of HCV care and referral to a specialist; however, only 33% of patients attended an HCV specialist appointment. 70% of patients who have not accessed specialist care have been seen at the STD clinics 2 or more times since a diagnosis of HCV.
We identified a high prevalence of HCV infection in the BCHD STD clinics. Despite continuing to access care and patient navigation services at the STD clinic, attendance at specialist HCV appointments have remained low. As HCV treatments become simpler and more tolerable, STD clinics have the potential to serve as HCV treatment sites.
J. Lasola, None
C. P. Chaulk, None
K. G. Ghanem, None
K. Page, None
D. Thomas, None
M. Sulkowski, None