Methods: UCM is funded to conduct expanded HIV testing and linkage to care at 13 sites on the South and West Side of Chicago. In 2014 we initiated HCV screening as an integrated part of this program at the lead institution. A weekly report of all patients tested and the results of testing is made available each week to the HIV linkage to care coordinator. Ultimate responsibility for HCV test notification and linkage to care is designated to the HIV/HCV program.
Results: Testing volumes increased from 2,935 tests in 2013 to 4,644 for the period from 1/1/14 to 3/31/15 (a 25 % increase in testing rate). Three hundred and fifty-three (7.6 %) of patients tested positive on the antibody screen. One hundred and ninety (54 %) had a positive confirmatory viral load, 21 % had a negative confirmatory test (74), and 25 % (89) have not yet been tested. Seventy-two percent of positives were African American, 14 % were Caucasian, 4 % were Hispanic, 2.5 % were Asian, and the remainder were other, mixed, or unknown. Sixty-four percent were male, 36 % female. Seventy-one percent were in the recommend birth cohort. It is not known if other patients were tested based on risk factors or clinic symptoms. Seventy-eight (22 %) had private insurance, and the remainder had government insurance or were uninsured. Seventy-seven (40 %) of confirmed positives had an APRI score. Of these, 55.8 % had a score < 0.7, 14.3 % had a score of .7 to 1.0 (high likelihood of significant fibrosis), and 29.9 % had a score of > 1.0 (high likelihood of cirrhosis). So far 55 % have been linked to care.
Conclusion: Integrating HCV screening into a program for expanded HIV screening and linkage to care has increased testing volumes. The vast majority (72 %) with confirmatory testing are true positives. APRI scores identified a high proportion of patients likely to have severe fibrosis or cirrhosis. This is being used to rank list patients to prioritize which patients are linked to an HCV provider. The high proportion of patients with public insurance or without insurance will make prior authorization for treatment difficult.
Y. Chenn, None
D. Pitrak, Gilead: Grant Investigator , Grant recipient
ViroPharma: Grant Investigator , Grant recipient and Research grant
Merck: Grant Investigator , Grant recipient and Research grant