Theme: Clinical Research Year: 2018
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.
We reviewed the charts of patients admitted to an inpatient service at Dartmouth-Hitchcock
Medical Center (DHMC) who had positive HCV serology in 2016.
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.
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