title: Implementing hospital-based baby boomer hepatitis C virus screening and linkage to care: Strategies, results, and costs.
abstract: OBJECTIVE
  The US Preventive Services Task Force recommends 1-time hepatitis C virus (HCV) screening of all baby boomers (born 1945-1965). However, little is known about optimal ways to implement HCV screening, counseling, and linkage to care. We developed strategies following approaches used for HIV to implement baby boomer HCV screening in a hospital setting and report results as well as costs.
  
  
  METHODS
  Prospective cohort of 6140 baby boomers admitted to a safety-net hospital in South Texas from December 1, 2012 to January 31, 2014 and followed to December 10, 2014.
  The HCV screening program included clinician/staff education, electronic medical record algorithm for eligibility and order entry, opt-out consent, anti-HCV antibody test with reflex HCV RNA, personalized inpatient counseling, and outpatient case management. Outcomes were anti-HCV antibody-positive and HCV RNA-positive results.
  
  
  RESULTS
  Of 3168 eligible patients, 240 (7.6%) were anti-HCV positive, which was more likely (P < 0.05) for younger age, men, and uninsured. Of 214 (89.2%) patients tested for HCV RNA, 134 (4.2% of all screened) were positive (chronic HCV). Among patients with chronic HCV, 129 (96.3%) were counseled, 108 (80.6%) received follow-up primary care, and 52 (38.8%) received hepatology care. Five patients initiated anti-HCV therapy. Total costs for start-up and implementation for 14 months were $286,482.
  
  
  CONCLUSIONS
  This inpatient HCV screening program diagnosed chronic HCV infection in 4.2% of tested patients and linked >80% to follow-up care. Yet access to therapy is challenging for largely uninsured populations, and most programmatic costs of the program are not currently covered.
authors.affiliation: Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.|Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.affiliation: Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.|Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Taylor
authors.affiliation: Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.|Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Hanson
authors.affiliation: Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Perez
authors.affiliation: Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Ludivina
authors.initials: L
authors.lastname: Hernandez
authors.affiliation: University Health System, San Antonio, Texas.
authors.forename: Roberto
authors.initials: R
authors.lastname: Villarreal
authors.affiliation: Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Poornachand
authors.initials: P
authors.lastname: Veerapaneni
authors.affiliation: Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Kristin
authors.initials: K
authors.lastname: Fiebelkorn
mesh_terms: D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D005791:Patient Care / Q000191:economics* / Q000379:methods; D010865:Pilot Projects; D011158:Population Growth; D011446:Prospective Studies