Theme: Clinical Research Year: 2018
Background:
The rise in injection drug use in the rural US has led to increased admissions for injectionrelated conditions. Hepatitis C (HCV) infection might be diagnosed during such episodes of
acute care. Linkage to HCV care in this group has been difficult, especially in rural settings.
Methods:
We reviewed the charts of patients admitted to an inpatient service at Dartmouth-Hitchcock
Medical Center (DHMC) who had positive HCV serology in 2016.
Results:
In 2016, 504 inpatients were screened for HCV, of which 65 (13%) had positive serology. Of
these, 50 (77%) had follow up HCV RNA testing, yielding 38 (76%) detectable results. Of the
53 with detected (38) or unknown viremia (15), 5 died on the index admission, 1 was
discharged to hospice, 16 were referred to hepatology (GI) clinic and 11 to infectious
disease (ID) clinic. Twenty received no referral.
Thirty-nine (73%) had a substance use disorder (SUD), of which 32 (82%) were actively
using and 7 (18%) were in recovery. Thirty-three (85%) had ever injected.
Through December 31, 2017, 15 (31%) of the surviving 48 patients had no follow up at
DHMC. Fourteen (29%) followed up in GI clinic, 11 (23%) in ID clinic and 8 (17%) in other
clinics. Only 5 (10%) were treated for HCV and achieved cure, all of which had followed up
in the GI clinic.
The odds of follow-up or treatment were independent of a history of SUD. Providers deferred
treatment due to ongoing substance use or a focus on more urgent medical issues.
Conclusion:
Only 10% of patients screened positive for HCV during an inpatient admission to a rural
academic medical center received treatment for HCV in the year following their diagnosis.
Disclosure of Interest Statement:
No author has received funding from or has financial interests in entities relevant to this
study.