Urban emergency departments (ED) seem to be able to detect new HCV infections at a high rate, but it is unknown the extent to which individuals screened in the ED can progress to treatment and cure. We evaluate the HCV Continuum of Care for patients identified with HCV in two urban EDs, and consider the results in the context of outcomes from ambulatory screening venues where 2-10% of chronically infected patients are treated.
This is a multicenter retrospective cohort study of two ED HCV screening programs. Patients who screened HCV antibody reactive between May 1 – October 31, 2014 were followed for up to 18 months. The main outcome was the absolute number and proportion of eligible patients who completed each stage of the HCV Continuum of Care.
There were 3,704 ED patients estimated to have undiagnosed HCV infection, and screening identified 532 (14.4%) HCV-antibody reactive patients. Of the 532 HCV-antibody reactive patients, 435 completed viral load testing (82%), of which 301 were chronically infected (69%). Of the 301 chronically infected patients, 158 had follow up arranged (52%), of which 97 attended their appointment (61%), of which 24 began treatment (25%), and of which 19 achieved a SVR (79%).
Urban EDs serve patients with poor access to preventative care services who have a high prevalence of HCV infection. Because ED patients identified with HCV infection can progress to treatment and cure with rates comparable to ambulatory care settings, implementation of ED HCV screening should be expanded.