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NYS Report HCV Testing Law Evaluation Report Jan 2016,
excerpts listed below, pdf attached
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Download the PDF here
"Flanigan, Colleen A (HEALTH)"
Subject: NYS Hepatitis C Testing Law Evaluation Report
Date: April 21, 2016 7:22:58 AM EDT
Good morning,
The New York State Department of Health (NYSDOH) is pleased to share the evaluation report for the NYS Hepatitis C Testing Law. The law mirrors the Centers for Disease Control and Prevention (CDC)'s expanded HCV screening recommendations, which were issued in 2012 and called for offering a one-time HCV screening test to "baby boomers" born between 1945 and 1965. If the screening test is positive, the law requires the provision of follow-up health care, including an HCV diagnostic test. The law was enacted to increase HCV testing, and ensure timely diagnosis and linkage to care.
To determine the impact of the law, the NYSDOH drew from multiple data sources that assessed testing levels in New York before and after the law went into effect. The data included a survey of laboratories reporting HCV screening test volume data, Medicaid data, HCV surveillance data, a sample of electronic health records from care providers serving underserved communities in New York City, self-reported data from statewide population surveys, and surveys of medical providers.
Overall, marked increases were observed in the number of HCV screening tests and screening rates in the first year following the enactment of the HCV testing law. These increases were consistent with the expected impact of the law on testing volume and testing rates, and these observations were corroborated using multiple data sources. Increases were observed almost immediately after enactment of the law and remained steady over time at levels much higher than the years before. Smaller increases were noted in the number of people who accessed HCV care following a positive HCV screening test component.
Key findings from the various evaluation components can be found in the attached report.
Best,
Colleen Flanigan
Colleen Flanigan, RN, MS
Director, Viral Hepatitis Section
New York State Department of Health
AIDS Institute
Empire State Plaza, Corning Tower – 429
Albany, NY 12237
(o) 518-486-6806
(f) 518-474-2749
Email: colleen.flanigan@health.ny.gov
EXCERPTS from Report:
"Another source of information to assess changes in HCV testing levels is the NYS Behavioral Risk Factor Surveillance System (BRFSS), a statewide population-based survey that included the question – "Have you ever been tested for hepatitis C (HCV)? Do not count tests you may
have had as part of a blood donation." Between 2013 and 2014, the number of NYS residents born between 1945 and 1965 answering "Yes" to this question is estimated to have increased by 26.6% from 1.02 million to 1.29 million, an uptick of 270,000 persons in a single year. The size of the observed increase should be interpreted with caution due to the small sample size of the survey, however. The increase in the percentage of NYS residents born between 1945 and 1965 who have ever been tested for HCV was 6.7%, from 25.4% in 2013 to 32.1% in 2014. By region, the percentage increase in NYC is higher at 13.2%, compared to NYS exclusive of NYC at 2.5%. In 2014, new questions were added to the BRFSS to assess the extent of HCV test offer and test acceptance in targeted medical settings. Among the respondents who received
medical care in the past 12 months from an inpatient unit of a hospital or from a primary care provider, 17% of the NYS residents born between 1945 and 1965 reported being offered an
HCV test when presenting for care in an inpatient unit, compared to 11% among those who received care from other primary care providers. Based on self-reported data, the low observed offer rates may be due in part to the difficulty of recollection of an event that happened within the last 12 months. Nonetheless, 71% of respondents who received a test offer said they accepted the test."
"Two statewide surveys of NYS-licensed medical providers conducted in 2015 provided additional information on providers' knowledge and practices with regard to the HCV Testing Law. In a sample of 594 primary care physicians surveyed, 67% indicated that they had heard of the law prior to receiving the survey. Eighty-six percent indicated that they offered HCV testing as a part of routine patient care during 2014, and 52% said they routinely tested patients born between 1945 and 1965 for HCV. In a parallel survey of Nurse Practitioners and Physician Assistants (N=458), 66% indicated that they had heard of the law prior to receiving the survey.
Seventy-six percent indicated that they offered HCV testing as a part of routine patient care during 2014, 52% said they routinely tested patients born between 1945 and 1965 for HCV, and 51% said they routinely tested patients born between 1945 and 1965. The similarities in responses for these questions from two independent samples are quite remarkable. Barriers to routinely offering HCV testing remain, however. The most frequently cited barriers included having limited time with patients (70% among MDs/DOs; 78% among NPs and PAs), having limited experience treating patients for HCV infection (61% among MDs/DOs; 76% among NPs and PAs), and having limited experience and knowledge of HCV and HCV testing (52% among MDs/DOs; 72% among NPs and Pas)."
"Overall, there were increases in linkage to care rates post law enactment. For both data sets, increases were greater for the Rest of State (ROS) when compared to NYC. The review of surveillance data showed a 39.8% increase for ROS compared to a smaller increase in NYC (9.0%). Similar outcomes were reported when utilizing the Medicaid data, which showed an overall increase of 35%. Linkage to care rates were higher in ROS (53%) compared to NYC (28%)."
"Overall, participants in Albany (N=5) expressed what they felt were numerous challenges around implementing the HCV Testing Law in their practice and with their patients whereas participants in NYC (N=11) did not seem to experience the same kind of challenges as those in Albany. More NYC participants had effectively implemented the law in their practices and spoke in favor of the law than those in Albany. Specifically, primary care providers in Albany expressed
concerns over insurance coverage, that it was an unfunded mandate, that they are not convinced that treatment improves quality of life and/or extends life, that their patient population is not at risk, that their patient population is uninformed about HCV, and that their patients have more life threatening problems to deal with. In contrast, primary care providers in NYC stated that they had invested a lot of time and energy into education around HCV testing, that they focus on it being a treatable condition, that there are many options for treatment available and
that there is a benefit to the patient and that is why there is a mandate."
"Conclusions and Future Directions
The NYS HCV testing law serves as the first legislation aimed at increasing the number of New Yorkers that know their HCV status. Marked increases were observed in the number of HCV screening tests and screening rates in the first year following the enactment of the HCV testing law. These increases were consistent with the expected impact of the law on testing volume 7 and testing rates, and these observations were corroborated using multiple data sources.
Increases were observed almost immediately after enactment of the law and remained steady over time at levels much higher than the years before.
Smaller increases were noted in the number of people who accessed HCV care following a positive HCV screening test component. Inherent limitations to the data sources used to evaluate this component restricted the ability to accurately assess the impact of the law on linkage to care. The implementation of HCV reflex testing and the reporting of negative HCV RNA test results will allow the development of better measures to ascertain whether someone has received follow-up health care following a positive HCV screening test. In addition to the
data limitations, limited capacity for HCV care and treatment, especially among HCV specialists, may have impacted timely linkage to care. In some areas of the state, wait times for appointments can exceed six months. There are also limited resources available to conduct active linkage to care activities, to ensure someone with a positive screening test gets linked to follow-up health care.
The NYS HCV Testing Law is due to expire in January 2020. The NYSDOH will continue to monitor the implementation and impact of the HCV Testing Law. Future directions include determining the feasibility of offering HCV screening among baby boomers visiting urban emergency departments; conducting a review of hospital HCV testing policies and procedures to ensure compliance with the new law; and validating the proxies used to measure linkage to care.
Additional work will also be done to address the burden of HCV disease outside of the baby boomer cohort. There is a growing epidemic of heroin use in NYS. People who inject drugs (PWID) are most at risk for HCV infection. Since 2007, the NYSDOH has investigated clusters of new HCV cases among young people who inject drugs and live in non-urban areas. The AIDS Institute will continue develop programs and activities aimed at preventing HCV infection among PWID, especially young PWID. Finally, the NYSDOH will continue to attempt to leverage other resources to develop a comprehensive HCV program in NYS."
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