Disclosures: Singal reports research support from Gilead and AbbVie. Please see the full study for all other authors’ relevant financial disclosures.
December 21, 2020
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Mailed outreach, inreach effective for HCV screening

Disclosures: Singal reports research support from Gilead and AbbVie. Please see the full study for all other authors’ relevant financial disclosures.
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A combination of inreach and mailed outreach was an effective hepatitis C screening strategy among hard-to-reach populations, according to study results.

Amit G. Singal, MD, MS, from the department of internal medicine at University of Texas Southwestern, and colleagues wrote that barriers to effective screening programs have made HCV eradication difficult in the United States.

Previous studies have shown that interventions such as inreach using electronic medical record (EMR) alerts, primary care provider and/or patient education, and outreach can increase HCV screening,” they wrote. “However, there are limited data evaluating the effectiveness of these interventions in socioeconomically disadvantaged and racially diverse patient populations — those in greatest need for screening.”

Researchers conducted a pragmatic randomized clinical trial comprising 12,386 patients (median age, 60 years; 46.5% Hispanic, 33% Black, 16% white) within a large, safety-net health system. They randomly assigned patients to receive inreach with an EMR reminder to providers or inreach plus a mailed HCV screening outreach. The combination outreach also included a process to promote HCV RNA testing among patients with positive HCV antibody and linkage to care.

The primary outcome was completion of HCV antibody testing within 3 months of randomization.

In their intent-to-treat analysis, researchers found that HCV screening completion was higher among the patients who received inreach plus outreach compared with those who received inreach alone at 3 months (14.6% vs. 7.4%; P < .001), as well as at 6 months (17.4% vs. 9.8%; P < .001).

In patients who completed HCV screening within 6 months, a higher proportion of patients in the combination group with positive antibody results also completed RNA testing within 3 months (81.1% vs. 57.1%; P = .02). Linkage to care did not differ between groups.

“Mailed outreach, combined with inreach, is an effective strategy to increase HCV screening among baby boomers,” Singal and colleagues wrote. “Although their implementation may present a financial burden to healthcare systems, strategies must be developed to improve screening completion, particularly among difficult-to-reach populations, if we are to realize the goal of HCV elimination.”