title: Public health clinic-based hepatitis C testing and linkage to care in Baltimore.
abstract: Testing and linkage to care are important determinants of hepatitis C virus (HCV) treatment effectiveness. Public health clinics serve populations at high risk of HCV. We investigated their potential to serve as sites for HCV testing, initiation of and linkage to HCV care. Cross-sectional study of patients accessing sexually transmitted infection (STI) care at the Baltimore City Health Department (BCHD) STI clinics, from June 2013 through April 2014 was conducted. Logistic regression was used to assess factors associated with HCV infection and specialist linkage to care. Between 24 June 2013 and 15 April 2014, 2681 patients were screened for HCV infection. Overall, 189 (7%) were anti-HCV positive, of whom 185 (98%) received follow-up HCV RNA testing, with 155 (84%) testing RNA positive. Of 155 RNA-positive individuals, 138 (89%) returned to the STI clinic for HCV RNA results and initial HCV care including counselling regarding transmission and harm reduction in alcohol, and 132 (85%) were referred to a specialist for HCV care. With provision of patient navigation services, 81 (52%) attended an offsite HCV specialist appointment. Alcohol use and lack of insurance coverage were associated with lower rates of specialist linkage (OR 0.4 [95% CI 0.1-0.9] and OR 0.4 [95% CI 0.1-0.9], respectively). We identified a high prevalence of HCV infection in BCHD STI clinics. With availability of patient navigation services, a large proportion of HCV-infected patients linked to off-site specialist care.
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Baltimore City Health Department, Baltimore, MD, USA.
authors: O
authors: O
authors: Falade-Nwulia
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: S H
authors: SH
authors: Mehta
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: J
authors: J
authors: Lasola
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: C
authors: C
authors: Latkin
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Baltimore City Health Department, Baltimore, MD, USA.
authors: A
authors: A
authors: Niculescu
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: C
authors: C
authors: O'Connor
authors: Baltimore City Health Department, Baltimore, MD, USA.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: P
authors: P
authors: Chaulk
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: K
authors: K
authors: Ghanem
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Baltimore City Health Department, Baltimore, MD, USA.
authors: K R
authors: KR
authors: Page
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: M S
authors: MS
authors: Sulkowski
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: D L
authors: DL
authors: Thomas
mesh_terms: D000328:Adult; D015142:Baltimore; D003430:Cross-Sectional Studies; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D011635:Public Health Administration / Q000379:methods*; D055815:Young Adult
keywords: HCV treatment; Implementation science; hazardous alcohol consumption; rapid testing; sexually transmitted infections clinic