Background: Direct acting antivirals (DAAs) have made chronic Hepatic C virus (HCV) a treatable condition, defined as sustained viral resistance (SVR), after completion of an 8-12 week treatment course. We initiated HCV screening in the ED in 2016 and have linked 56% of our chronic HCV patients to care. However, ED-based HCV linkage-to-care outcomes are not well known.<
Methods: Here, we report linkage-to-care outcomes (initiation of DAA, obtaining SVR) of patients who tested positive for chronic HCV through an ED based routine testing program. We analyzed a subset of patients that had chronic HCV diagnosed through ED based screening that were referred to our hospital system hepatology clinic for downstream care. Next, we asked whether these patients were started on DAA and if they obtained SVR.
Results: We tested 33,462 patients for HCV in 31 months (15% of the ED volume). The prevalence of chronic HCV was 4.1%, representing 1,052 patients. We were able to link 584 patients to care. We specifically examined 62 patients that were linked to our own hospital system hepatology clinic to analyze treatment and outcome patterns. Of these 62 patients, 14 (22.6%) started a DAA and all 14 sustained virologic response. We also discuss potential reasons for non-treatment.
Conclusion: In order to scale up ED-based HCV screening during an acute care encounter, understanding downstream follow up and treatment outcomes is critical. Analyzing linkage outcomes may improve the experiences of future linkage efforts and increase medical management with higher rates of SVR, increasing the impact of an ED screening program. Understanding decisions for non-treatment (such as ongoing opioid use disorder) may also allow co-design of other programs in the ED to manage patients with multiple disease states (e.g. IVDA and HCV).