Methods: We collaborated with the Durham County Department of Public Health in Durham, NC to integrate routine HCV testing at the human services facility. Targeted screening with HCV antibody and reflex RNA was conducted based on US guidelines (e.g. birth cohort, intravenous drug use [IVDU]) in clinical areas and the department of social services. To support linkage to care, a “bridge counselor” or social worker assisted chronic HCV-infected persons with transportation, initial appointments with HCV specialists, and access to other services. We analyzed the HCV prevalence, risk factors, and the care continuum among this population.
Results: From March 2016 to February 2018, targeted HCV screening was conducted among 2,775 persons, of which 84 (3%) were HCV antibody positive and RNA positive. Among persons identified with chronic HCV infection, the median age was 48.5 (interquartile range (IQR): 23-76), 48 (57%) were male, and 53 (63%) were African-American. HCV infected persons had multiple risk factors including past or current IVDU use (n=38, 45%), history of unlicensed tattoo/ear piercings (n=35, 42%), and prior incarceration (n=31, 38%); no HIV co-infections were identified. An assessment of the care continuum demonstrated that the majority with chronic HCV infection received post-test counseling (96%), met with the bridge counselor (70%) and attended their first medical appointment (74%). However, only 49% were prescribed HCV treatment and 24% achieved sustained virologic response.
Conclusion: Implementation of targeted screening with HCV antibody and reflex RNA in a public health setting, coupled with bridge counseling, can identify persons with chronic HCV infections and link them to care. However, only half received HCV treatment and a fourth achieved HCV cure, highlighting the gaps in the care continuum where future interventions should be directed.
G. McKnight, Gilead Sciences: Grant Investigator , Grant recipient .
J. Thayer, Gilead Sciences: Grant Investigator , Grant recipient .
A. Hilton, Gilead Sciences: Grant Investigator , Grant recipient .