Only one out of three baby boomers diagnosed with hepatitis C virus infection in the ED was successfully linked to care for the virus, according to a retrospective cohort study published in Open Forum Infectious Diseases.
“Here, we characterized the ‘no show phenomenon’ to HCV care and the potential role played by demographic and clinical factors, similarly to what has been described in HIV care,” James W. Galbraith, MD, associate professor of emergency medicine at the University of Alabama at Birmingham, and colleagues wrote.
James W. Galbraith
An estimated 50% of individuals with HCV are unaware of their infection and more than 60% of those aware of their infection are not receiving medical care. EDs are high-yield settings for detecting HCV infection, the researchers said, but data on subsequent linkage to care are limited. Galbraith and colleagues assessed failure rates of linkage to HCV care among baby boomers after their ED diagnosis. They also aimed to describe the clinical and demographic characteristics of baby boomers infected with HCV and identify the factors associated with failures in linking them to care.
From September 2013 to June 2014, opt-out HCV screening was conducted on 4,371 persons born from 1945 to 1964 who presented at the University of Alabama at Birmingham ED. Demographic data, ICD-9 codes and information about clinic visits were collected for patients who tested positive. A linkage coordinator facilitated referrals for patients with HCV, who were followed until February 2015, allowing 8 to 17 months of follow-up.
Overall, 332 baby boomers who had reactive HCV antibody and detectable plasma RNA were followed. The mean age of patients at the time of screening was 57.3 years; 70% were men and 61% were black.
Thirty-seven percent reported substance abuse problems, 30% had psychiatric diagnoses and 9% were cirrhotic. During a median follow-up of 433 days, 48% of patients required hospitalization at least one time.
During the follow-up period, only 35% of patients were linked to care for HCV — defined as attending at least one visit at an HCV clinic within the hospital system.
In multivariable analysis, the odds of failure in linkage to care were significantly higher for white men (adjusted OR = 2.57; 95% CI, 1.03-6.38) and uninsured individuals (aOR = 5.16; 95% CI, 1.43-18.63). Odds of failure were lower for patients with cirrhosis (aOR = 0.36; 95% CI, 0.14-0.92) and with access to primary care (aOR = 0.2; 95% CI, 0.1-0.41).
Galbraith and colleagues noted that individuals may have postponed HCV care “in favor of competing health priorities and/or competing demands such as food security, unstable housing, other financial constraints and/or lack of transportation.”
“[Linkage to care] interventions in this setting should be robust in order to address significant lack of access to care, frequent competing priorities and meet the need of high-yield screening strategies,” the researchers concluded. “Further research is warranted for optimal linkage to HCV care practices in ED settings.” – by Sarah Kennedy
Disclosure: Please see the full study for a list of all researchers’ relevant financial disclosures.