Article ; Online: Hepatitis C Among High-Risk Alabamians: Disease Burden and Screening Effectiveness.
The Journal of infectious diseases
2020 Volume 222, Issue Suppl 5, Page(s) S365–S375
Abstract: Background: The effectiveness of hepatitis C testing and linkage-to-care (LTC) is poorly characterized in low-resource jurisdictions facing gaps in harm reduction, including illegality of syringe exchange services. Effectiveness of a community-based ... ...
| Abstract | Background: The effectiveness of hepatitis C testing and linkage-to-care (LTC) is poorly characterized in low-resource jurisdictions facing gaps in harm reduction, including illegality of syringe exchange services. Effectiveness of a community-based test/LTC program was evaluated in Alabama. Methods: In 2016-2018, shelters, drug treatment centers (DTCs), AIDS organizations, and Federally Qualified Health Centers (FQHCs) engaged in screening/LTC. A coordinator navigated individuals to confirm viremia and link to substance use treatment or primary care with hepatitis C prescribers. Results: Point-of-care (POC) tested 4293 individuals (10% [427] antibody-positive, 71% [299/419] RNA performed, 80% [241/299] viremia confirmed) and 93% linked to care (225/241). Electronic medical record (EMR)-based reflex strategy screened 4654 (15% [679] antibody positive, 99% [670/679] RNA performed, 64% [433/679] viremia confirmed) and 85% linked to care (368/433). We observed higher odds of RNA confirmation in EMR-based reflex versus POC (OR, 2.07; P < .0001) and higher odds of LTC in EMR-based reflex versus POC (OR, 1.51; P < .0001). Overall, 53% individuals tested were nonbaby boomers. Conclusions: In Alabama, screening at high-risk settings identified significant hepatitis C burden and reflex testing outperformed point-of-care linkage indicators. Colocating testing in DTCs and treatment in FQHCs provided key LTC venues to at-risk younger groups. |
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| MeSH term(s) | Adult ; Alabama/epidemiology ; Community Health Services/organization & administration ; Community Health Services/statistics & numerical data ; Cost of Illness ; Counseling/organization & administration ; Counseling/statistics & numerical data ; Drug Users/statistics & numerical data ; Female ; Hepacivirus/genetics ; Hepacivirus/immunology ; Hepacivirus/isolation & purification ; Hepatitis C/diagnosis ; Hepatitis C/epidemiology ; Hepatitis C/therapy ; Hepatitis C/transmission ; Hepatitis C Antibodies/isolation & purification ; Humans ; Male ; Mass Screening/organization & administration ; Mass Screening/statistics & numerical data ; Middle Aged ; Point-of-Care Testing/organization & administration ; Point-of-Care Testing/statistics & numerical data ; Prospective Studies ; RNA, Viral/isolation & purification ; Risk Factors ; Substance Abuse, Intravenous/complications ; Substance Abuse, Intravenous/rehabilitation ; Vulnerable Populations/statistics & numerical data |
| Chemical Substances | Hepatitis C Antibodies ; RNA, Viral |
| Language | English |
| Publishing date | 2020-10-26 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 3019-3 |
| ISSN | 1537-6613 ; 0022-1899 |
| ISSN (online) | 1537-6613 |
| ISSN | 0022-1899 |
| DOI | 10.1093/infdis/jiaa207 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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