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Successful Integration of Hepatitis C Virus Point-of-Care Tests into the Denver Metro Health Clinic

DOI: 10.1155/2013/528904

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Abstract:

Background. The Centers for Disease Control and Prevention (CDC) recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV), including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC) testing into standard operations at an urban STD clinic. Methods. The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC). All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative). Focus groups were conducted with triage staff, providers, and linkage-to-care counselors. Results. Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care. Conclusion. DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection. 1. Background Chronic hepatitis C virus (HCV) infection affects 3.2 million persons in the US [1] and approximately 45%–85% of infected persons are unaware of their infection [2]. The Centers for Disease Control and Prevention (CDC) recommends HCV testing for those persons born during 1945–1965 [2] and those most likely to be infected with HCV [3], including persons with human immunodeficiency virus (HIV) [4, 5]. Persons with HIV are disproportionately affected, with 25%–30% of HIV-infected persons being coinfected with HCV [6]. The CDC further recommends linkage to care (LTC) and treatment as appropriate for individuals with confirmed infection. Sexually transmitted disease (STD) clinics are examples of integrated healthcare facilities that provide a broad range of healthcare services (i.e., screening and testing, linkage to care) to clients in need of insurance assistance, charitable care, and/or anonymity. CDC’s 2010 STD treatment guidelines recommend routine HCV testing of HIV-infected persons [7]. This recommendation suggests that clinics that reach persons at high risk for HIV infection may also reach HCV-infected persons. Prior to the CDC recommendation, one study from the mid-2000s showed only 54% of HIV-infected clients

References

[1]  G. L. Armstrong, A. Wasley, E. P. Simard, G. M. McQuillan, W. L. Kuhnert, and M. J. Alter, “The prevalence of hepatitis C virus infection in the United States, 1999 through 2002,” Annals of Internal Medicine, vol. 144, no. 10, pp. 705–714, 2006.
[2]  B. D. Smith, R. L. Morgan, G. A. Beckett, et al., “Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965,” Morbidity and Mortality Weekly Report, vol. 61, no. 4, pp. 1–32, 2012.
[3]  Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease, “Centers for Disease Control and Prevention,” Morbidity and Mortality Weekly Report, vol. 47, no. 19, pp. 1–39, 1998.
[4]  1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus, “U.S. Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA),” Morbidity and Mortality Weekly Report, vol. 48, no. 10, pp. 61–66, 1999.
[5]  J. E. Kaplan, H. Masur, and K. K. Holmes, “Guidelines for preventing opportunistic infections among HIV-infected persons—2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America,” Morbidity and Mortality Weekly Report, vol. 51, no. -8, pp. 1–52, 2002.
[6]  M. J. Alter, “Epidemiology of viral hepatitis and HIV co-infection,” Journal of Hepatology, vol. 44, no. 1, pp. S6–S9, 2006.
[7]  K. A. Workowski and S. Berman, “Sexually transmitted diseases treatment guidelines, 2010,” Morbidity and Mortality Weekly Report, vol. 59, no. 12, pp. 1–113, 2010.
[8]  K. W. Hoover, M. Butler, K. A. Workowski et al., “Low rates of hepatitis screening and vaccination of HIV-infected MSM in HIV clinics,” Sexually Transmitted Diseases, vol. 39, no. 5, pp. 349–353, 2012.
[9]  U. D. o.H.a.H. Services, Ed., FDA Approves Rapid Test For Antibodies To Hepatitis C Virus, FDA News Releases: Silver Spring, 2010.
[10]  S. R. Lee, K. W. Kardos, E. Schiff et al., “Evaluation of a new, rapid test for detecting HCV infection, suitable for use with blood or oral fluid,” Journal of Virological Methods, vol. 172, no. 1-2, pp. 27–31, 2011.
[11]  B. D. Smith, J. Drobeniuc, A. Jewett et al., “Evaluation of three rapid screening assays for detection of antibodies to hepatitis C virus,” Journal of Infectious Diseases, vol. 204, no. 6, pp. 825–831, 2011.
[12]  V. A. Moyer, “Screening for hepatitis C virus infection in adults: U.S. preventive services task force recommendation statement,” Annals of Internal Medicine, vol. 159, no. 5, pp. 349–357, 2013.
[13]  A. C. J. Strauss, Basics of Qualitative Research: Grounded Theory Procedures and Techniques, Newbury Park, Calif, USA, 1990.
[14]  B. D. Smith, E. Teshale, A. Jewett et al., “Performance of premarket rapid hepatitis C virus antibody assays in 4 national human immunodeficiency virus behavioral surveillance system sites,” Clinical Infectious Diseases, vol. 53, no. 8, pp. 780–786, 2011.

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