Category: Federal Forum Posters
Purpose: Patients born between 1945 to 1965 are considered a high risk population for HCV and Veterans are at a 25 percent higher chance of having contracted the disease as compared to the general population. HCV antibody testing is not routinely done through patients’ primary care providers. Our HCV staff used multiple campaigns to increase Veteran testing including provider education, patient education through letters and phone calls urging them to get tested, and community education by speaking at various Veteran-sponsored events. To further improve test rates, a POC antibody test protocol was implemented for pharmacists and clinical technicians to increase testing among rural, homeless and patients without transportation.
Methods: Pharmacist from HCV clinic worked in collaboration with ancillary testing coordinator from laboratory service to establish POC testing protocol for HCV. A policy was established that defined when the tests could be used such as at health fairs, stand down events, and homeless outreach visits. Patient’s electronic chart was checked before testing was conducted to prevent duplicate testing. Specimens collected are capillary fingerstick whole blood taken by using a lancet device. The POC kits purchased include single use test device, developer solution, reusable test stands, and specimen collection loops. Internal quality control built in to the device was used for every patient. Pharmacy staff were trained and certified to use the POC kits online and hands-on use. Laboratory conducted validation verification using specificity and sensitivity tests with statistic agreement of 95 percent confidence level prior to field use. Pharmacy staff was given access to entering results into patient’s electronic chart. Once the POC test was conducted results were ready in 20 to 40 minutes and recorded on approved patient log. If a patient had a negative result, no further action was needed other than to notify the patient. If a positive antibody resulted, then follow-up HCV RNA viral load was needed to confirm active infection.
Results: In fiscal year 2018, there are 1899 patients needing to be tested out of the total 12,798 in the birth cohort. There have been four events attended thus far in which a total of 41 patients have been tested. This represents two percent of the population needing to be tested. Of the patients tested, zero have been positive.
Conclusion: HCV POC protocol allowed an increase in testing among patients who are unable to come to the laboratory, increased convenience for patients who live far from the laboratory facilities, increased awareness and education for patients whose contact have been limited due to no address or phone number listed, and increased testing, education and awareness among all Veterans regardless if they were in the birth cohort. Because limited staff was used to initiate the POC testing, the quantity of patients reached was not as many as we would have liked. There are still many more patients in the birth cohort that need to be tested who do not attend these staffed outreach events. Although invitation letters about local area events were sent to patients in advance, only a few of the patients who received the letters would show up. POC testing could be improved if staff could attend more outreach events regularly and continue to do outreach among the homeless population. In 2017, HCV homeless outreach was done twice weekly, but in 2018, outreach was stopped due to changes in staffing priorities. There are additional outreach events planned through Fiscal Year 2018. Overall, the program has been a success with an increase in the number of patients being tested, for whom without testing would not have been done at all.
Jennifer Siilata– Clinical Pharmacy Specialist, Department of Veterans Affairs, Fresno, CA