title: Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program.
abstract: BACKGROUND
  Many of the five million Americans chronically infected with hepatitis C (HCV) are unaware of their infection and are not in care.
  
  
  OBJECTIVE
  We implemented and evaluated HCV screening and linkage-to-care interventions in a community setting.
  
  
  METHODS
  We developed a comprehensive, community-based HCV screening and linkage-to-care program in a medically underserved neighborhood with high rates of HCV infection in Philadelphia, Pennsylvania. We provided patient navigation services to enroll uninsured patients in insurance programs, facilitate referrals from primary care physicians and link patients to an HCV infectious disease specialist with intention to treat and cure.
  
  
  METHODS
  Philadelphia residents were recruited through street outreach.
  
  
  METHODS
  We measured anti-HCV seroprevalence and diagnosis, linkage and retention in care outcomes for chronically infected patients.
  
  
  RESULTS
  We screened 1,301 participants for HCV; anti-HCV seroprevalence was 3.9 % and 2.8% of all patients were chronically infected. Half of chronically infected patients were newly diagnosed; the remaining patients were aware of infection but not in care. We provided confirmatory RNA testing and results, assisted patients with attaining insurance and linked most chronically infected patients to a primary care provider. The biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64% of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment.
  
  
  CONCLUSIONS
  Non-clinical screening programs with patient navigator services are an effective means to diagnose, link, retain and re-engage patients in HCV care. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with HCV.
authors: Division of Infectious Diseases, Drexel University College of Medicine, Philadelphia, PA, USA.
authors: Stacey B
authors: SB
authors: Trooskin
authors: Joanna
authors: J
authors: Poceta
authors: Caitlin M
authors: CM
authors: Towey
authors: Annajane
authors: A
authors: Yolken
authors: Jennifer S
authors: JS
authors: Rose
authors: Najia L
authors: NL
authors: Luqman
authors: Ta-Wanda L
authors: TW
authors: Preston
authors: Philip A
authors: PA
authors: Chan
authors: Curt
authors: C
authors: Beckwith
authors: Sophie C
authors: SC
authors: Feller
authors: Hwajin
authors: H
authors: Lee
authors: Amy S
authors: AS
authors: Nunn
mesh_terms: D000328:Adult; D000368:Aged; D019090:Case Management / Q000458:organization & administration; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research / Q000379:methods; D019698:Hepatitis C, Chronic / Q000175:diagnosis*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008507:Medically Underserved Area; D008875:Middle Aged; D062526:Patient Navigation / Q000458:organization & administration*; D010414:Pennsylvania; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration; D012309:Risk-Taking; D012959:Socioeconomic Factors