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. 2023 Mar 31;15(4):913.
doi: 10.3390/v15040913.

Leave No-One Behind: A Retrospective Study of Hepatitis C Testing and Linkage to Care for Hospital Inpatients

Christine Roder  1   2   3 , Carl Cosgrave  3 , Kathryn Mackie  3 , Stuart K Roberts  4 , Margaret E Hellard  1 , Amanda J Wade  1   2   3 , Joseph S Doyle  1   5
Affiliations

Leave No-One Behind: A Retrospective Study of Hepatitis C Testing and Linkage to Care for Hospital Inpatients

Christine Roder et al. Viruses. .

Abstract

Hospital admissions are a missed opportunity to engage people living with hepatitis C virus (HCV) into care. This study aimed to describe the proportion of hospital inpatients and emergency department (ED) patients identified with hepatitis C who were subsequently linked to care and treatment at a metropolitan health service in Melbourne, Australia. Data were collected retrospectively from hospital databases (admissions, notifiable diseases, and pharmacy) for all adults admitted or attending the ED with separation coding indicating hepatitis C infection from March 2016 to March 2019. There were 2149 patients with at least one separation with hepatitis C coding. 15.4% (331/2149) had a documented antibody test, 4.6% (99/2149) had a documented RNA test, and 8.3% (179/2149) had a DAA prescription dispensed by hospital pharmacy. Antibody positivity was 95.2% (315/331) and RNA (when completed) was detected in 37.4% (37/99). Hepatitis specialist units had the highest rate of hepatitis C coded separations and RNA testing (39/88; 44.3%), mental health had the highest rate of antibody testing (70/276; 25.4%). Emergency had the lowest rate of antibody testing (101/1075; 13.7%) and the third highest rate of RNA testing (32/94; 34.1%), but the highest rate of RNA detected (15/32; 46.9%). This study highlights key steps to improve the care cascade. Simplified diagnostic pathways, expansion of hepatitis C care services, and clear in-hospital pathways to link patients to care would be beneficial in this setting. To scale up hepatitis C testing and treatment as part of national elimination strategies, hospital systems need to target interventions to their local data.

Keywords: cascade of care; hepatitis C; linkage to care; testing.

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Conflict of interest statement

C.R. has received funding from Gilead Sciences that is not related to this study. M.H. has received funding from AbbVie and Gilead Sciences which are not related to this study. A.W. has received funding from AbbVie and NHMRC that is not related to this study. J.D. has received funding from AbbVie and Gilead Sciences which is not related to this study. There is no other conflict of interest to declare.

Figures

Figure 1
Figure 1
Hepatitis C care cascade for patients with a hepatitis C coded episode at the Alfred Hospital from 2016 to 2019. Viral Hepatitis Mapping Project, National Report 2020 data [5] were used to estimate the number of people living with hepatitis C in the hospitals catchment area (blue). The care cascade determined using the hospitals datasets (admissions, pathology, and pharmacy) is shown in orange. The orange portion of the treated column shows patients who also had an antibody- and/or RNA-positive test, while the grey portion shows patients with a hepatitis C coded separation and evidence of treatment.
Figure 2
Figure 2
Hepatitis C care cascade for the Alfred Hospital 2016–2019 by specialty unit. The denominator (n) for all steps in the cascade is the patients with hepatitis C coded admissions in that specialty (Table 2). Treated includes patients who had a positive antibody or RNA test.
See this image and copyright information in PMC

References

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