Health disparities in hepatitis C screening and linkage to care at an integrated health system in southeast Michigan

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Health disparities in hepatitis C screening and linkage to care at an integrated health system in southeast Michigan

Authors

Bourgi, K.,Brar, I.,Baker-Genaw, K.

Citation
2016
PLoS ONE

11

8
Type
Retrospective cohort
Virus targets
Hepatitis C
Interventions
HCV testing and linkage to Care
Linkage to care
Screening and diagnosis
Testing
Setting
National
Target populations
General Population
Country of development
United States of America
Target location
United States of America
DOI
10.1371/journal.pone.0161241
Testing strategy
Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test
Laboratory-based antibody test
Laboratory-based PCR/RNA (confirmatory) test
Countries of included studies
United States of America

Health outcomes

Linkage to care

Testing strategy

Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test

Abstract

With recommended screening for hepatitis C among the 1945-1965 birth cohort and advent of novel highly effective therapies, little is known about health disparities in the Hepatitis C care cascade. Our objective was to evaluate hepatitis C screening rates and linkage to care, among patients who test positive, at our large integrated health system. We used electronic medical records to retrospectively identify patients, in the birth cohort, who were seen in 21 Internal Medicine clinics from July 2014 to June 2015. Patients previously screened for hepatitis C and those with established disease were excluded. We studied patients' sociodemographic and medical conditions along with provider-specific factors associated with likelihood of screening. Patients who tested positive for HCV antibody were reviewed to assess appropriate linkage to care and treatment. Of 40,561 patients who met inclusion criteria, 21.3% (8657) were screened, 1.3% (109) tested positive, and 30% (30/100) completed treatment. Multivariate logistic regression showed that African American race, male gender, electronic health engagement, residency teaching clinic visit, and having more than one clinic visit were associated with higher odds of screening. Patients had a significant decrease in the likelihood of screening with sequential interval increase in their Charlson comorbidity index. When evaluating hepatitis C treatment in patients who screened positive, electronic health engagement was associated with higher odds of treatment whereas Medicaid insurance was associated with significantly lower odds. This study shows that hepatitis C screening rates and linkage to care continue to be suboptimal with a significant impact of multiple sociodemographic and insurance factors. Electronic health engagement emerges as a tool in linking patients to the hepatitis C care cascade. Copyright © 2016 Bourgi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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21 Jan 2021