title: Strategies for hepatitis C testing and linkage to care for vulnerable populations: point-of-care and standard HCV testing in a mobile medical clinic.
abstract: Despite new Hepatitis C virus (HCV) therapeutic advances, challenges remain for HCV testing and linking patients to care. A point-of-care (POC) HCV antibody testing strategy was compared to traditional serological testing to determine patient preferences for type of testing and linkage to treatment in an innovative mobile medical clinic (MMC). From 2012 to 2013, all 1,345 MMC clients in New Haven, CT underwent a routine health assessment, including for HCV. Based on patient preferences, clients could select between standard phlebotomy or POC HCV testing, with results available in approximately 1 week versus 20 min, respectively. Outcomes included: (1) accepting HCV testing; (2) preference for rapid POC HCV testing; and (3) linkage to HCV care. All clients with reactive test results were referred to a HCV specialty clinic. Among the 438 (32.6 %) clients accepting HCV testing, HCV prevalence was 6.2 % (N = 27), and 209 (47.7 %) preferred POC testing. Significant correlates of accepting HCV testing was lower for the "baby boomer" generation (AOR 0.67; 95 % CI 0.46-0.97) and white race (AOR 0.55; 95 % CI 0.36-0.78) and higher for having had a prior STI diagnosis (AOR 5.03; 95 % CI 1.76-14.26), prior injection drug use (AOR 2.21; 95 % CI 1.12-4.46), and being US-born (AOR 1.76; 95 % CI 1.25-2.46). Those diagnosed with HCV and preferring POC testing (N = 16) were significantly more likely than those choosing standard testing (N = 11) to be linked to HCV care within 30 days (93.8 vs. 18.2 %; p < 0.0001). HCV testing is feasible in MMCs. While patients equally preferred POC and standard HCV testing strategies, HCV-infected patients choosing POC testing were significantly more likely to be linked to HCV treatment. Important differences in risk and background were associated with type of HCV testing strategy selected. HCV testing strategies should be balanced based on costs, convenience, and ability to link to HCV treatment.
authors.affiliation: AIDS Program, Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA, jamie.morano@yale.edu.
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Morano
authors.forename: Alexei
authors.initials: A
authors.lastname: Zelenev
authors.forename: Andrea
authors.initials: A
authors.lastname: Lombard
authors.forename: Ruthanne
authors.initials: R
authors.lastname: Marcus
authors.forename: Britton A
authors.initials: BA
authors.lastname: Gibson
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D003237:Connecticut; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008952:Mobile Health Units; D010342:Patient Acceptance of Health Care; D018962:Phlebotomy; D019095:Point-of-Care Systems; D035862:Vulnerable Populations / Q000706:statistics & numerical data