Published in:
01-07-2015 | Original Research
Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program
Published in: Journal of General Internal Medicine | Issue 7/2015
Login to get accessABSTRACT
BACKGROUND
Many of the five million Americans chronically infected with hepatitis C (HCV) are unaware of their infection and are not in care.
OBJECTIVE
We implemented and evaluated HCV screening and linkage-to-care interventions in a community setting.
DESIGN
We developed a comprehensive, community-based HCV screening and linkage-to-care program in a medically underserved neighborhood with high rates of HCV infection in Philadelphia, Pennsylvania. We provided patient navigation services to enroll uninsured patients in insurance programs, facilitate referrals from primary care physicians and link patients to an HCV infectious disease specialist with intention to treat and cure.
PATIENTS
Philadelphia residents were recruited through street outreach.
MAIN MEASURES
We measured anti-HCV seroprevalence and diagnosis, linkage and retention in care outcomes for chronically infected patients.
KEY RESULTS
We screened 1,301 participants for HCV; anti-HCV seroprevalence was 3.9 % and 2.8 % of all patients were chronically infected. Half of chronically infected patients were newly diagnosed; the remaining patients were aware of infection but not in care. We provided confirmatory RNA testing and results, assisted patients with attaining insurance and linked most chronically infected patients to a primary care provider. The biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64 % of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment.
CONCLUSIONS
Non-clinical screening programs with patient navigator services are an effective means to diagnose, link, retain and re-engage patients in HCV care. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with HCV.