title: Hospital-Based Hepatitis C Screening of Baby Boomers in a Majority Hispanic South Texas Cohort: Successes and Barriers to Implementation.
abstract: To comply with the 2012 CDC recommendations for hepatitis C virus (HCV) screening, we implemented a new HCV screening program for patients born between 1945 and 1965 at a South Texas safety-net hospital.
  
  
  
  Patients with no HCV diagnosis or prior HCV test received an automated order for HCV antibody (anti-HCV) tests combined with reflex HCV ribonucleic acid (RNA) polymerase chain reaction. An inpatient counselor educated anti-HCV-positive patients. A bilingual patient navigator assisted newly diagnosed chronic HCV patients with linkage to primary and specialty care. We examined results for Hispanic vs. non-Hispanic patients in the first 10 months of project implementation in 2013-2014.
  
  
  
  Of 2,327 patients screened for HCV, the 192 (8%) patients who tested anti-HCV positive were younger than those who tested negative (56 vs. 58 years, respectively, p<0.001) and more likely to be male (p<0.001). Of the 167 anti-HCV-positive patients tested for HCV RNA, 108 (65%) were HCV RNA positive (5% of cohort). Barriers to care for HCV RNA-positive patients included a lack of health insurance, current substance abuse, incarceration, and homelessness. Hispanic HCV RNA-positive patients were more likely than non-Hispanic HCV RNA-positive patients to be substance abusers or incarcerated. Of all HCV RNA-positive patients, 103 patients (95%) received counseling, 94 patients (87%) were linked to primary care, 47 patients (44%) were linked to specialty care, and eight patients (7%) started treatment.
  
  
  
  The prevalence of anti-HCV-positive and chronically HCV-infected patients was higher than many Hispanic or non-Hispanic white cohorts. Most Hispanic patients newly diagnosed with chronic HCV had barriers to care for HCV infection that must be overcome if HCV screening is to reduce morbidity and mortality in this population.
authors.affiliation: University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX; University of Texas Health Science Center, Department of Medicine, Division of Infectious Diseases, San Antonio, TX.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Taylor
authors.affiliation: University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX; University of Texas Health Science Center, Department of Medicine, Division of Hospital Medicine, San Antonio, TX.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Hanson
authors.affiliation: University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX.
authors.forename: Poornachand
authors.initials: P
authors.lastname: Veerapaneni
authors.affiliation: University Health System, San Antonio, TX.
authors.forename: Roberto
authors.initials: R
authors.lastname: Villarreal
authors.affiliation: University of Texas Health Science Center, Department of Medicine, Division of Infectious Diseases, San Antonio, TX; University Health System, San Antonio, TX; University of Texas Health Science Center, Department of Pathology, San Antonio, TX.
authors.forename: Kristin
authors.initials: K
authors.lastname: Fiebelkorn
authors.affiliation: University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX; University of Texas Health Science Center, Department of Medicine, Division of General Internal Medicine, San Antonio, TX.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D003376:Counseling; D003955:Diagnostic Tests, Routine; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000175:diagnosis*; D006630:Hispanic or Latino; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D019982:Organizational Case Studies; D016133:Polymerase Chain Reaction; D016730:Program Development; D012367:RNA, Viral; D064876:Safety-net Providers; D013781:Texas; D014481:United States
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral