Background: Hepatitis C virus (HCV) infection is an epidemic that disproportionately affects those removed from the healthcare system. These populations include intravenous drug users (IVDU), incarcerated persons, and the homeless. In addition to screening in a variety of clinical settings, testing in non-clinical, community settings is necessary to identify all cases of HCV infection.
Methods: This study describes rapid HCV testing and retention in care at two drug and alcohol rehabilitation centers and two homeless shelters in New Orleans. At the initial screening visit, we collected demographic information, self-reported risk factors for infection, and characteristics that might affect retention in care. We surveyed the electronic medical records (EMR) at our referral sites to assess success in follow-up. We defined retention in care as patients attending their first follow-up appointment.
Results: Overall prevalence for HCV antibody among the four sites was 24% (73/308) ranging from 21-75% at individual sites. Prevalence was significantly higher at rehabilitation facilities as compared to homeless shelters (50% vs. 22%), which correlated with higher rates of self-reported IVDU (50% vs. 26%).
To analyze retention in care, we separated HCV antibody positive patients according to sites that provided transportation (n=25) versus those that did not (n=48). HCV positive patients with access to transportation attended their first follow-up appointments at significantly higher rates (68%) as compared to those without access to transportation (24%). RNA confirmation rates were similarly associated (45% vs. 9%) according to presence or absence of transportation assistance. Residential program membership was also significantly associated with increased retention rates (60% versus 28%).
Conclusion: The high prevalence of HCV infection among this group of patients further demonstrates the need for community-based screening. Providers may be hesitant to initiate similar programs because this population contends with a variety of structural and cultural barriers to care. Further studies are needed to characterize the association between retention in care, residential program membership, and transportation assistance.
J. Andrews, None