Dataset Information

Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System.

ABSTRACT:

Context

Birth cohort ("baby boomer") screening represents a well-validated strategy for the identification of asymptomatic hepatitis C-infected patients. However, successful linkage of newly diagnosed patients to antiviral therapy has been more difficult to accomplish.

Objective

To analyze the results of a systemwide birth cohort screening program in a US community health care system.

Design

We analyzed the data from an ongoing hepatitis C virus (HCV) screening and treatment program that was established at NorthShore University Health System in 2015. Hepatitis C virus screening by primary care providers was prompted through automated Best Practice and Health Maintenance alerts. Patient visits and screening orders were tracked using a customized HCV dashboard. Virologic, demographic, and treatment data were assessed and compared with those of a cohort of patients with previously established HCV infection.

Results

Since program inception, 61 8161 (64.3%) of the entire NorthShore baby boomer population of 96 001 patients have completed HCV antibody testing, and 160 patients (0.26%) were antibody positive. Of 152 antibody-positive patients who underwent HCV RNA testing, 53 (34.2%) were viremic. A total of 39 of 53 patients (73.6%) underwent antiviral therapy and achieved a sustained virologic response. Compared with patients identified through screening, a comparison cohort of patients with previously established HCV had more advanced fibrosis and significantly lower dropout rates. The COVID-19 pandemic was associated with a decrease in the number of outpatient visits of screening-eligible patients and with a reduction in HCV screening rates.

Conclusion

Our data demonstrate the electronic medical records-assisted systemwide implementation of HCV birth cohort screening and successful linkage to antiviral therapy in a community-based US multihospital system.

SUBMITTER: Zijlstra MK

PROVIDER: S-EPMC9528933 | biostudies-literature | 2022 Nov-Dec 01

REPOSITORIES: biostudies-literature

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Publications

Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System.

Zijlstra Michael K MK Fidel Nague Kristine K Louie Patrick P Imas Polina P Sonnenberg Amnon A Fimmel Claus J CJ

Journal of public health management and practice : JPHMP 20220827 6

<h4>Context</h4>Birth cohort ("baby boomer") screening represents a well-validated strategy for the identification of asymptomatic hepatitis C-infected patients. However, successful linkage of newly diagnosed patients to antiviral therapy has been more difficult to accomplish.<h4>Objective</h4>To analyze the results of a systemwide birth cohort screening program in a US community health care system.<h4>Design</h4>We analyzed the data from an ongoing hepatitis C virus (HCV) screening and treatmen ...[more]

PMID: 36194824

Similar Datasets

Project description:BackgroundIn the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection.ObjectiveTo estimate the cost-effectiveness of birth-cohort screening.DesignCost-effectiveness simulation.Data sourcesNational Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources.Target populationAdults born from 1945 through 1965 with 1 or more visits to a primary care provider annually.Time horizonLifetime.PerspectiveSocietal, health care.InterventionOne-time antibody test of 1945-1965 birth cohort.Outcome measuresNumbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER).Results of base-case analysisCompared with the status quo, birth-cohort screening identified 808,580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN+R) for treated patients, screening increased QALYs by 348,800 and costs by $5.5 billion, for an ICER of $15,700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN+R treatment for treated patients, screening increased QALYs by 532,200 and costs by $19.0 billion, for an ICER of $35,700 per QALY saved.Results of sensitivity analysisThe ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states.LimitationEmpirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce.ConclusionBirth-cohort screening for HCV in primary care settings was cost-effective.Primary funding sourceDivision of Viral Hepatitis, Centers for Disease Control and Prevention.

Project description:BackgroundBirth cohort screening is recommended for hepatitis C virus (HCV) and underserved populations are disproportionally affected by HCV. Little is known about the influence of race on the HCV care continuum in this population.ObjectiveTo assess the cascade of HCV care in a large racially diverse and underserved birth cohort.DesignRetrospective cohort study using electronic medical record data abstracted until August 31, 2017.Patients34,810 patients born between 1945 and 1965 engaged in primary care between October 1, 2014, and October 31, 2016, within the safety-net clinics of the San Francisco Health Network.Main measuresRate of hepatitis C testing, hepatitis C treatment, and response to therapy.ResultsCohort characteristics were as follows: median age 59 years, 57.6% male, 25.5% White (20.6% Black, 17.7% Latino, 33.0% Asian/Pacific Islander (API), 2% other), and 32.6% preferred a non-English language. 99.7% had an HCV test (95.4% HCV antibody, 4.3% HCVRNA alone). Among HCV antibody-positive patients (N = 4587), 22.9% were not tested for confirmatory HCVRNA. Among viremic patients (N = 3673), 20.8% initiated HCV therapy, 90.6% achieved sustained virologic response (SVR) and 8.1% did not have a SVR test. HCV screening and treatment were highest in APIs (98.7 and 34.7% respectively; p < 0.001). Blacks had the highest chronic HCV rate (22.2%; p < 0.001). Latinos had the lowest SVR rate (81.3%; p = 0.01). On multivariable analysis, API race (vs White, OR 1.20; p = 0.001), presence of HIV co-infection (OR 1.58; p = 0.02), presence of chronic kidney disease (OR 0.47; p < 0.001), English (vs non-English) as preferred language (OR 0.54; p = 0.002), ALT (OR 0.39 per doubling; p < 0.001), and HCVRNA (OR 0.83 per 10-fold increase; p < 0.001) were associated with HCV treatment.ConclusionsDespite near-universal screening, gaps in active HCV confirmation, treatment, and verification of cure were identified and influenced by race. Tailored interventions to engage and treat diverse and underserved populations with HCV infection are needed.

Dataset Information

Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System.

Context

Objective

Design

Results

Conclusion

Publications

Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System.

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