Objective: To characterize the continuum of HCV testing and care among adolescents and emerging adults in a large national sample of US FQHCs.
Methods: We used the OCHIN electronic medical record to create a retrospective cohort of 13 to 21-year-olds who had a least one outpatient visit at any of 98 participating US FQHCs across 19 states from 2012-2017. Primary outcome was HCV testing during this timeframe. We also identified predictors of HCV screening using multivariable logistic regression adjusting for age, sex, race/ethnicity, and substance use.
Results: Among 269,287 youth who met inclusion criteria, 54.7% were female, 37.6% White, 33.5% Hispanic, 17.6% Black, and 11.3% other. Mean [SD] age at first HCV screening was 18.5 [2.2] years. Over the study period, 2.5% (6849/269,287) were tested for HCV and 153 (2.2%) had reactive HCV testing. Of those, 117 (76.5%) had confirmatory RNA testing and 65 (55.6%) had detectable RNA. Thirty-five percent (325/933) with ICD-9 codes for opioid use disorder (OUD) and 8.9% (2080/23,345) with any ICD-9 code for drug use were tested for HCV. Only 10.6% (728/6849) of individuals tested for HCV had also been tested for human immunodeficiency virus (HIV). Older age (19-21 vs. 13-15 years old at study end, aOR 5.64, 95% CI 5.13-6.19), Black race (aOR 1.88, 95% CI 1.76-2.00), and ICD-9 codes for substance use disorder, in particular amphetamine (aOR 5.82, 5.10-6.64), opioids (aOR 3.50, 2.92-4.19), cocaine (aOR 2.90, 2.43-3.47), or cannabis (aOR 2.46, 2.31-2.62) were independently associated with HCV testing in multivariable analysis.
Conclusion: During the current opioid crisis, only a third of adolescents/young adults diagnosed with OUD in a large national sample of FQHCs were tested for HCV. In addition, only 10% of those tested for HCV were also screened for HIV. Initiatives are needed to increase HCV and HIV screening among at-risk youth at FQHCs.
R. L. Epstein,
K. Mayer, None
J. Puro, None
C. R. Horsburgh, None
B. P. Linas, None
S. A. Assoumou, None