539. Barriers to Successful Linkage to Care Among HCV Positive Individuals Presenting to a Major Tertiary Medical Center on Long Island, New York.
Session: Poster Abstract Session: Hepatitis B and C in Varied Settings
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Lier_Audun_HCV_IDSA2017.pdf (546.7 kB)
  • Background: In 2013, the US Preventive Services Task Force made a grade B recommendation to offer HCV screening for at-risk individuals and baby boomers (born between 1945-1965). However, only 50% of HCV positive individuals are aware they are infected, and far fewer attend an outpatient appointment and are initiated on treatment (Linkage to Care: LTC). The aim of this study is to assess the factors affecting LTC among HCV positives in a suburban tertiary medical center on Long Island, NY.

    Methods: A retrospective chart review was performed on all patients with ICD-9 or 10 diagnostic codes for HCV positive antibody from January 2016 to March 2017 at Stony Brook University Hospital. Data was collected for HCV RNA, LTC, demographics, insurance and employment status, psychiatric diagnosis, comorbid medical conditions, substance use disorder, injection drug use, liver and kidney function, level of fibrosis.

    Results: A total of 155 cases (61.9% male; mean age 53.9 years) had a positive HCV antibody, 110 (71%) had a follow-up HCV RNA test and 35.1% were LTC. The comorbidities present in this cohort were psychiatric disease (54.9%), cirrhosis (22.6%), HBV infection (14.1%) and HIV (8.5%). In the univariate analysis, new inpatient HCV diagnosis (OR=0.09, 95%CI:0.02-0.36, p=0.001), employment (OR=3, 95%CI:1.01-8.95, p=0.049) and history of substance use disorder (OR=0.38, 95%CI:0.15-0.96, p=0.043) were associated with LTC. In the logistic regression analysis, inpatient HCV diagnosis was negatively correlated with LTC (OR: 0.03, 95%CI: 0.002-0.41, p=0.009). Two hot spots of HCV infection were identified in south central Suffolk County.

    Conclusion: In this population, new inpatient HCV diagnosis and history of substance use disorder were less likely to have LTC, whereas those employed were more likely to have LTC. Innovative interventions in the inpatient setting may be beneficial for newly diagnosed HCV cases to improve LTC after discharge.

    Audun Lier, MD, MPH1, Kerim Odekon, MD1, Ruth Abeles, MD, MS1, Silvia Bronson, MS2, Jacqueline Colon, MHA2, Inderjit Mann, MD3, Lily Coyle, BS4, Kalie Smith, BS4, Bettina C. Fries, MD, FIDSA5 and Luis A. Marcos, MD, MPH6, (1)Internal Medicine, Stony Brook University Hospital, Stony Brook, NY, (2)Stony Brook University Hospital, Stony Brook, NY, (3)Stony Brook University School of Medicine, Stony Brook, NY, (4)Stony Brook University, Stony Brook, NY, (5)Department of Medicine (Division of Infectious Disease), Stony Brook University Hospital, Stony Brook, NY, (6)Infectious Diseases, Stony Brook University School of Medicine, Stony Brook, NY

    Disclosures:

    A. Lier, None

    K. Odekon, None

    R. Abeles, None

    S. Bronson, None

    J. Colon, None

    I. Mann, None

    L. Coyle, None

    K. Smith, None

    B. C. Fries, None

    L. A. Marcos, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.