Predictors of linkage to care for a nontargeted emergency department hepatitis C screening program

• Published in: The American journal of emergency medicine Vol. 38; no. 7; pp. 1396 - 1401
• Main Authors: Blackwell, Joshua A., Rodgers, Joel B., Franco, Ricardo A., Cofield, Stacey S., Walter, Lauren A., Galbraith, James W., Hess, Erik P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2020; Elsevier Limited
• Subjects: Baby boomers; Bipolar disorder; Chronic infection; Chronic obstructive pulmonary disease; Comorbidity; Drug use; Emergency medical care; Emergency medical services; HCV; Hepatitis; Hepatitis C; HIV; Homeless people; Homelessness; Human immunodeficiency virus; Infections; Intervention; Linkage to care; Mental disorders; Nontargeted screening; Opt-out screening; Patients; Primary care; Ribonucleic acid; RNA; Schizophrenia; Sociodemographics; Substance use; Targeted screening; Variables; Alabama; United States > US; Targeted screening; Ab; Opt-out screening; Linkage to care; FOCUS; STROBE; HCV; LTC; LTCC; Hepatitis C; Nontargeted screening
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.11.034

•EDs play a crucial role in Hepatitis C screening and linkage to care.•Predictors of linkage to care failure may be used to enhance linkage efforts.•Predictors of linkage failure were identified for 1674 patients with Hepatitis C.•Young age, white race, homelessness, substance use, & mental illness increased risk.•Medical comorbidities and HIV co-infection protected against linkage failure. We implemented a nontargeted, opt-out HCV testing and linkage to care (LTC) program in an academic tertiary care emergency department (ED). Despite research showing the critical role of ED-based HCV testing programs, predictors of LTC have not been defined for patients identified through the nontargeted ED testing strategy. In order to optimize health outcomes for patients with HCV, we sought to identify predictors of LTC failure. This was a retrospective cohort study of adult patients who were tested for HCV in the ED between August 2015 and September 2018 and were confirmed to have chronic HCV infection through RNA testing. We used logistic regression to assess the relationship between candidate predictors and the primary outcome, LTC failure, which was defined as a patient not being seen by an HCV treating provider after discharge from the ED. Of 53,297 patients tested, 1,674 (3.1%) had HCV on confirmatory testing, and 355 (21%) linked to care. Predictors of LTC failure included younger age (OR 0.96, 95% CI 0.95–0.97), white race (OR 1.65, 95% CI 1.23–2.22), homelessness (OR 1.91, 95% CI 1.19–3.08), substance use (OR 1.77, 95% CI 1.34–2.34), and comorbid psychiatric illness (OR 2.16, 95% CI 1.59–2.94). Patients with significant medical comorbidities (OR 0.57, 95% CI 0.41–0.78) or HIV co-infection (OR 0.11, 95% CI 0.03–0.46) were less likely to experience LTC failure. One in five HCV-infected patients identified by ED-based nontargeted testing successfully linked to an HCV treating provider. Predictors of LTC failure may guide the development of targeted interventions to improve LTC success.