Austin T Jones1, Lisa Moreno-Walton2, Torrence Tran3, Christopher Briones3, Kanayo Okeke-Eweni2, Rachael Stevens4, Kacie Isaacson5, Hua He6, Patricia J Kissinger6. 1. Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA. Electronic address: austin.jones@denverem.org. 2. Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA. 3. Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA. 4. Tulane University School of Medicine, New Orleans, LA, USA. 5. Department of Emergency Medicine, Emory University, Atlanta, GA, USA. 6. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Douglas A E White; Erik S Anderson; Sarah K Pfeil; Tarak K Trivedi; Harrison J Alter Journal: Ann Emerg Med Date: 2015-08-04 Impact factor: 5.721
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Brianna L Norton; William N Southern; Meredith Steinman; Bryce D Smith; Joseph Deluca; Zachary Rosner; Alain H Litwin Journal: Clin Gastroenterol Hepatol Date: 2016-04-19 Impact factor: 11.382
Authors: Catelyn Coyle; Anne C Moorman; Tyler Bartholomew; Gary Klein; Helena Kwakwa; Shruti H Mehta; Deborah Holtzman Journal: Hepatology Date: 2019-03-26 Impact factor: 17.425
Authors: James W Galbraith; Ricardo A Franco; John P Donnelly; Joel B Rodgers; Jordan M Morgan; Andres F Viles; Edgar T Overton; Michael S Saag; Henry E Wang Journal: Hepatology Date: 2015-01-28 Impact factor: 17.425
Authors: Erik S Anderson; James W Galbraith; Laura J Deering; Sarah K Pfeil; Tamara Todorovic; Joel B Rodgers; Jordan M Forsythe; Ricardo Franco; Henry Wang; N Ewen Wang; Douglas A E White Journal: Clin Infect Dis Date: 2017-06-01 Impact factor: 9.079