457. Hepatitis C in the Correctional-Community Continuum of Care: Poor Baseline Linkage Rates and Early Improvement with Care Coordination
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Background: High volumes of hepatitis C (HCV)-infected detainees pass through US jails. However, short lengths of stay and competing priorities upon release complicate linkage to HCV care. We investigated linkage rates for patients with HCV following release from New York City (NYC) jails and describe a care coordination program (CCP) we initiated in June 2015 to improve linkage rates.

Methods: We conducted a pre-post intervention study to assess rates of linkage related to the CCP. We used NYC Department of Health surveillance data to assess pre-intervention linkage rates for patients with chronic HCV seen in a correctional health clinic at Bellevue Hospital Center from January 2014-June 2015. Linkage was defined as an HCV viral load or genotype <90 days in the community after release from an index incarceration. The CCP consists of a needs assessment, HCV education, and appointment scheduling for detainees, followed by reminder calls and appointment escort by a community patient navigator after re-entry. Statistical significance was determined using xtests.

Results: Of 52 patients in the pre-intervention group, 24 (46.2%) were released from their index jail stay. Of those released, 10/24 (42%) were reincarcerated within a median of 247 days (IQR 129-318). The remaining 28 individuals were not released from their index incarceration and transferred to state prison. Of the 26 enrolled in the CCP as of April 2016, 13 (50%) have been released (6 linked, 4 pending linkage, and 3 not linked), 9 (34.6%) have not yet been released, and 4 (15.4%) have been transferred to state prison. Criteria for linkage to care within <90 days in the pre-intervention and intervention groups respectively were met by 3/24 (12.5%) vs. 5/9 thus far (55.6%) (p=0.01) and overall by 11/24 (45.8%) vs. 6/9 thus far (66.7%) (p=0.29).

Conclusion: Pre-intervention linkage rates were low among HCV-infected detainees. While this study is ongoing, linkage in <90 days was significantly higher in the intervention group though not overall. These data provide early evidence that an integrated community-based CCP with jail-based transitional care coordinators may be effective in improving timely linkage to HCV care following release from jail.

Matthew Akiyama, MD, MSc1, Ross Macdonald, MD2, Alison Jordan, MSW2, Fabienne Laraque, MD, MPH3, Devin Columbus, MA4, Michael Maurantonio, BS4, Jessie Schwartz, RN, MPH3, Vinh Pham, MD, PhD4 and Ellie Carmody, MD, MPH4, (1)Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, (2)New York City Health + Hospitals, Correctional Health Services, New York, NY, (3)Viral Hepatitis Surveillance, Prevention and Control Program, New York City Department of Health & Mental Hygiene, New York, NY, (4)Division of Infectious Diseases and Immunology, New York University Medical Center, New York, NY

Disclosures:

M. Akiyama, Gilead Sciences: Grant Investigator , Grant recipient

R. Macdonald, None

A. Jordan, None

F. Laraque, None

D. Columbus, None

M. Maurantonio, None

J. Schwartz, None

V. Pham, None

E. Carmody, Gilead Sciences: Grant Investigator , Grant recipient

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