Meet Them Where They Are: Successful Implementation Of Hepatitis C Screening And Linkage In Substance Abuse Clinics, Georgia, USA

Author: Marie Sutton, Winona Holloway, Britney Johnson Cole Youngner

Theme: Epidemiology & Public Health Research Year: 2017

Authors: Marie Sutton1, Winona Holloway1 Britney Johnson1 Cole Youngner1

1Imagine Hope, Inc.

Background: An estimated 2.7–3.9 million Americans have chronic Hepatitis C Virus (HCV) infection, with 50–70% unaware of their status. Current HCV testing recommendations led to increased screening in clinical settings, but there remains a gap in risk-based HCV testing among high risk populations, particularly injection drug users (IDUs). With 50-80% of IDUs becoming HCV-infected within five years, targeted testing and treatment approaches are critical to address the syndemic impacts of HCV infection among IDUs.

Methods: In April 2015, Imagine Hope expanded an HIV testing program offering free HCV testing/linkage to care in multiple substance abuse facilities across Georgia, including medication assistance treatment clinics. Routine HCV screening was offered to all clients, in addition to confirmatory RNA testing. Linkage coordinators offered access to care, treatment, and support groups.

Results: From April 2015-March 2017, 9,515 individuals were tested for HCV in 20 rural, urban and suburban clinics in Georgia. Of those, 11% (1,053) were HCV antibody positive (Ab+). Among HCV Ab+ clients, 82% (860) received RNA testing, and 74% (637) of those RNA tested were confirmed HCV RNA+. Linkage to care was successful among 43% (272) HCV RNA+ substance users. Among Ab+ individuals 74.4% were born outside 1945-1965, and 24% were under 30 years old.

Conclusion: Incorporating routine HCV testing in substance abuse facilities is feasible, and can be modeled off existing HIV screening programs with high-risk clients.  Among IDUs, HCV prevalence is high while infection awareness is low. Navigators, partnerships with treatment providers in primary care settings, and support groups enhance linkage. RNA screening prior to the 1st medical appointment expedites linkage; RNA positive clients are more motivated to keep appointments; and RNA negative clients do not clog an already burdened system of care for the uninsured.

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