A Cascade of Care of Patients with Hepatitis C Infection in a Rural State

Authors

Wollelaw Agmas, Maine Medical CenterFollow
Wendy Craig, MaineHealth Research InstituteFollow
Kathleen FairfieldFollow
Brian F. King, Maine Medical Center, Portland, MaineFollow
Elizabeth Eisenhardt, MaineHealthFollow
Kinna Thakarar, Maine Medical Center Division of Infectious Disease, Tufts University School of MedicineFollow

Submission Type

Original Research

Abstract

Introduction: The substance misuse epidemic has fueled an increase in hepatitis C virus (HCV) infections. Despite the availability of sensitive screening and curative treatment, relatively few people are aware of their diagnosis and engaged in care. In this study, we aimed to identify local gaps in HCV care and inform strategies for improvement.

Methods: In this retrospective study, we assessed adult patients seen at a tertiary care center from 2015 to 2019 and who were eligible for HCV screening based on recommendations from the Centers for Disease Control and Prevention. Inclusion criteria were birth from 1945 to 1965, long-term dialysis treatment, alanine aminotransferase greater than 35 U/L for 6 months or more, and/or a diagnosis of opioid use disorder (OUD), HIV/AIDS, or hepatitis B virus (HBV) infection. We summarized the HCV cascade of care with descriptive statistics and used logistic regression to identify factors associated with HCV screening.

Results: We identified 4948 patients eligible for HCV screening, of whom 47% were female, 54% were male; 7% were Black, 83% were White, and 10% were Other/Unknown; and 87% were born between 1945 and 1965. Among the patients, 2791/4948 (56%) were screened and 124/2791 (4%) were identified to have chronic HCV infection, of whom 12/124 (10%) were linked to care, ever treated, and cured. Patients with HCV included 63/124 (51%) with OUD and 65/124 (52%) with HBV coinfection. All risk factors for HCV were independently associated with HCV screening, except OUD (aOR, 1.2; 95% CI, 0.9-1.6; P = .28).

Discussion: We identified multiple gaps in the HCV cascade of care at our institution. Our findings, paired with data from the Veterans Health Administration and national research, indicate a need for more comprehensive strategies for HCV screening and intervention.

Conclusions: Our findings will help to direct strategies for improving HCV detection and subsequent enrollment into care, particularly for patients with OUD.

Recommended Citation

Agmas, Wollelaw; Craig, Wendy; Fairfield, Kathleen; King, Brian F.; Eisenhardt, Elizabeth; and Thakarar, Kinna (2023) "A Cascade of Care of Patients with Hepatitis C Infection in a Rural State," Journal of Maine Medical Center: Vol. 5 : Iss. 2 , Article 1.
Available at: https://doi.org/10.46804/2641-2225.1137