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Hepatitis C care continuum at a safety-net health system
among adults enrolled in probations in Denver, Colorado
- AASLD-EASL HCV Special Conference Miami 2019 Feb 1
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Reported by Jules Levin
2019 AASLD/EASL HCV Special Conference 01-02 February 2019, Miami, FL
Kevin Kamis MPH 1, Sarah Rowan MD 1,2, Hermione Hurley MD 2,3, Scott Prendergast 4, Dean McEwen MBA1,
David Wyles MD 2
(1.) Denver Public Health (2.) Denver Health and Hospital Authority Department of Infectious Diseases (3.) Denver Health and Hospital Authority Outpatient Behavioral Health Services (4.) Denver Adult Probation, Colorado Judicial Branch
"Over a third of probationers with DH medical records tested for HCV were seropositive, and the majority of these individuals had active HCV. A large drop off exists between testing positive for HCV RNA and being prescribed medications"
Hepatitis C care continuum at a safety-net health system among adults enrolled in probations in Denver, Colorado
Kevin Kamis, Sarah Rowan, Hermione Hurley, Scott Prendergast, Dean McEwen, David Wyles
ABSTRACT
Persons on probation constitute the largest subgroup of the corrections population in the US and outnumbered the combined prisoner/parolee population by nearly 1.3 million in 2016 [1-3]. This population remains understudied despite the fact that other justice-involved populations are known to be at increased risk for hepatitis C virus (HCV) [4]. We analyzed a cohort of recent adult probationers in Denver to establish baseline data on diagnosed HCV prevalence and the cascade of HCV care received at the local safety net health system.
Denver Adult Probations generated a list of individuals entering probation between 7/1/2016 and 7/31/201S8. Probabilistic matching using sex, first name, last name, and birthdate were used to identify individuals with a medical record at Denver Health (DH), a safety-net health system. DH medical records were reviewed for evidence of HCV testing between 4/9/2016 and 10/31/2018 and progression through the HCV treatment cascade.
8,904 individuals initiated probation between 7/1/2016 and 7/31/2018, and 6,920 (78%) of those individuals had DH medical records. 704 individuals were tested for HCV antibody (ab) during the study period, 217 (31%) of whom tested HCV ab positive. Of those positive for HCV ab, 100% were tested for HCV RNA, and 166 (76%) had detectable HCV RNA levels. 95 individuals were tested only for HCV RNA in the study period and of those, 66 (69%) had detectable HCV RNA. One individual with a previous equivocal HCV ab result and one individual with a previous HCV ab negative result later tested positive for HCV RNA. Five individuals spontaneously cleared the virus without treatment. Among those positive for RNA (234), 74% were male, 69% white, 10% black, and 20% Hispanic; 79% had Medicaid, 8% Medicare, 7% correctional care, 5% commercial insurance, and 2% had no coverage. Median age was 36 years (IQR: 29-49).Of the 229 individuals with persistent HCV RNA, 23% were prescribed HCV medication by a DH provider, 17% had a subsequent documented HCV RNA viral load below the lower limit of quantification (LLOQ), and 5% had documented sustained virologic response 12 weeks post treatment completion (SVR12). Of the 27 individuals who achieved HCV RNA < LLOQ without documented SVR12, 11 have not reached the SVR12 time point, and 16 never had SVR12 checked. One individual experienced treatment failure.
The vast majority of individuals in Denver Adult Probations had a DH medical record. Over a third of probationers with DH medical records tested for HCV were seropositive, and the majority of these individuals had active HCV. A large drop off exists between testing positive for HCV RNA and being prescribed medications, though the majority of those prescribed HCV medications progressed to undetectable HCV RNA viral loads. SVR12 documentation was incomplete due to loss to follow-up. Documented virologic failure was rare. Future efforts are needed to ensure individuals on probation are screened for HCV and linked to care.
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