Emergency department versus community screening on hepatitis C follow-up care

• Published in: The American journal of emergency medicine Vol. 56; pp. 151 - 157
• Main Authors: Jones, Austin T., Moreno-Walton, Lisa, Tran, Torrence, Briones, Christopher, Okeke-Eweni, Kanayo, Stevens, Rachael, Isaacson, Kacie, He, Hua, Kissinger, Patricia J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2022; Elsevier Limited
• Subjects: Aftercare; Ambulatory care; Antibodies; Community clinic; COVID-19; Drug use; Emergency department; Emergency medical care; Emergency Service, Hospital; Fibrosis; Hepacivirus; Hepatitis; Hepatitis C; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Humans; Infections; Infectious diseases; Linkage to care; Mass Screening; Mortality; Patients; Population; Retention; Retrospective Studies; RNA; Screening; Screening; Emergency department; Linkage to care; Hepatitis C; Community clinic
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2022.03.041

Emergency department (ED) hepatitis C virus (HCV) screening programs are proliferating, and it is unknown whether EDs are more effective than traditional community screening at promoting HCV follow-up care. The objective of this study was to investigate whether patients screened HCV seropositive (HCV+) in the ED are linked to care and retained in treatment more successfully than patients screened HCV+ in the community.
A retrospective cohort study was performed including patients screened HCV+ at twelve screening facilities in New Orleans, LA from March 1, 2015 to July 31, 2017. Treatment outcomes, including retention and time to follow-up care, were assessed using the HCV continuum of care model.
ED patients (n = 3008) were significantly more likely to achieve RNA confirmation (aRR = 1.91, 95% CI = 1.54–2.37), initiate HCV therapy (aRR = 2.23 [1.76–2.83]), complete HCV therapy (aRR = 1.77 [1.40–2.24]), and achieve HCV functional cure (aRR = 2.80 [1.09–7.23]) compared to community-screened patients (n = 322). ED screening was associated with decreased likelihood of fibrosis staging (aRR = 0.65 [0.51–0.82]) and no difference in linkage to specialty care (aRR = 1.03 [0.69–1.53]). In time to follow up, RNA confirmation occurred at faster rates in the ED (aHR = 2.26 [1.86–2.72]), although these patients completed fibrosis staging at slower rates (aHR = 0.49 [0.38–0.63]) than community patients.
Compared to community screening, HCV screening in the ED was associated with higher rates of disease confirmation, treatment initiation/completion, and cure. Our findings provide new evidence that EDs may be the most effective setting to screen patients for HCV to promote follow-up care.
•This study serves as the first comparison of ED and community HCV screening.•EDs demonstrate higher likelihood and faster rates of confirming HCV chronic disease.•ED screening is associated with higher likelihood of HCV treatment initiation/completion and cure.•ED surveillance may be most effective at promoting retention in HCV follow-up care.