The Massachusetts Hepatitis C Testing Cascade, 2014-2016

Validation of a Simplified Laboratory-Based HCV Clearance Definition Using New York City Hepatitis C Program and Surveillance Data

CONTEXT

Laboratory-based hepatitis C virus (HCV) clearance cascades are an important tool for health departments to track progress toward HCV elimination, but a laboratory-based definition of HCV clearance has not yet been validated.

OBJECTIVE

To compare agreement between a laboratory-based HCV clearance definition with a clinical cure definition.

DESIGN

Observational.

SETTING

New York City Department of Health and Mental Hygiene HCV surveillance system data and New York City hepatitis C linkage-to-care program data.

PARTICIPANTS

Linkage-to-care program participants who were diagnosed with hepatitis C and enrolled in the linkage-to-care program from July 1, 2016, through June 30, 2020.

MAIN OUTCOME MEASURE

Percent agreement between a laboratory-based HCV clearance definition (surveillance system) and a clinical cure definition (program data).

RESULTS

Among 591 program participants with known treatment outcome, the laboratory-based HCV clearance definition and clinical cure definition were concordant in 573 cases (97%).

CONCLUSIONS

A laboratory-based HCV clearance definition based on public health surveillance data can be a reliable source for monitoring HCV elimination.

Hepatitis C Cascades: Data to Inform Hepatitis C Elimination in the United States

The United States has a goal to eliminate hepatitis C as a public health threat by 2030. To accomplish this goal, hepatitis C virus (HCV) care cascades (hereinafter, HCV cascades) can be used to measure progress toward HCV elimination and identify disparities in HCV testing and care. In this topical review of HCV cascades, we describe common definitions of cascade steps, review the application of HCV cascades in health care and public health settings, and discuss the strengths and limitations of data sources used. We use examples from the Massachusetts Department of Public Health as a case study to illustrate how multiple data sources can be leveraged to produce HCV cascades for public health purposes. HCV cascades in health care settings provide actionable data to improve health care quality and delivery of services in a single health system. In public health settings at jurisdictional and national levels, HCV cascades describe HCV diagnosis and treatment for populations, which can be challenging in the absence of a single data source containing complete, comprehensive, and timely data representing all steps of a cascade. Use of multiple data sources and strategies to improve interoperability of health care and public health data systems can advance the use of HCV cascades and speed progress toward HCV elimination.

HCV Testing and Treatment in a National Sample of US Federally Qualified Health Centers during the Opioid Epidemic

BACKGROUND

Federally qualified health centers (FQHCs) serve diverse communities in the United States (U.S.) and could function as important venues to diagnose and treat hepatitis C virus (HCV) infections.

OBJECTIVE

To determine HCV testing proportion and factors associated with treatment initiation, and treatment outcomes in a large sample of FQHCs around the U.S.

DESIGN

Retrospective cohort study using electronic health records of three hundred and forty-one FQHC clinical sites participating in the OCHIN network in 19 U.S. states.

PARTICIPANTS

Adult patients (≥ 18 years of age) seen between January 01, 2012, and June 30, 2017.

MAIN MEASURES

HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 6 months after treatment initiation.

KEY RESULTS

Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8694 (9.8%) of individuals tested had reactive results. Of the 6357 with HCV RNA testing, 4092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 87% reached SVR. Having commercial insurance (aOR, 2.11; 95% CI, 1.46-3.05), older age (aOR, 1.07; 95% CI, 1.06-1.09), and being Hispanic/Latino (aOR, 1.87; 95% CI, 1.38-2.53) or Asian/Pacific Islander (aOR, 2.47; 95% CI, 1.46-4.19) were independently associated with higher odds of treatment initiation after multivariable adjustment. In contrast, women (aOR, 0.76; 95% CI, 0.60-0.97) and the uninsured (aOR, 0.15; 95% CI, 0.09-0.25) were less likely to initiate treatment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV.

CONCLUSIONS

Fewer than 20% of individuals with identified OUD were tested for HCV. SVR was lower than findings in other real-world cohorts. Measures to improve outcomes should be considered with the expansion of HCV management into community clinics.