The Centers for Disease Control and Prevention (CDC) recommend increased screening for Hepatitis C virus (HCV) with antibody testing, followed by confirmation of active infection and referral and linkage to care with a treating provider. We investigated rates of referral and linkage for patients screened for HCV at Bellevue Hospital Center (BHC), a large public hospital in New York City, to identify gaps in the HCV cascade of care.
We performed a retrospective chart review of all patients at BHC with a positive anti-HCV antibody test between January 2014 and February 2015. Referral to care was defined as a request for an appointment in hepatitis, infectious disease or gastroenterology clinic at BHC. Patients were linked to care if they had a visit to one of these clinics by the end of the review period in April 2015. Patients were excluded if they were under the custody of the Department of Corrections, as follow-up visits could not be tracked reliably. Additional exclusion criteria included death during the study period and undetectable viral RNA, as this indicates spontaneously cleared or successfully treated infection and does not routinely require specialist care. Patients were determined to be already linked to care if the HCV antibody was sent on or after the appointment date with an HCV-treating provider.
408 patients were eligible for review. For 49 patients (12%), the first HCV antibody during the study period was sent on or after the linkage date, suggesting either referral from an outside clinic with need for confirmatory testing at BHC, or prior linkage to care at BHC. 123 (30%) were newly referred to an HCV specialist. Of these, 59 (48%) were successfully linked to care at BHC.
Creating a cascade of HCV care for an individual hospital is useful to systematically identify gaps in referral and linkage. In our survey, a majority of eligible patients were not referred to care. Furthermore, about half of patients referred were linked. Quality improvements such as physician education seminars, automatic specialist referral and dedicated patient navigators have been implemented to address these gaps. Health systems can benefit from evaluating their own HCV care cascade to ensure patients do not get lost on the path to cure.
A. Liu, None
H. Lee, None
H. Horowitz, None
E. Carmody, None