title: Continuum of Care for Hepatitis C Virus Among Patients Diagnosed in the Emergency Department Setting.
abstract: Urban emergency departments (EDs) seem to be able to detect new hepatitis C virus (HCV) infections at a high rate, but it is unknown the extent to which individuals screened in the ED can progress to treatment and cure. We evaluate the HCV Continuum of Care for patients identified with HCV in 2 urban EDs, and consider the results in the context of outcomes from ambulatory screening venues where 2%-10% of chronically infected patients are treated.
  This is a multicenter, retrospective cohort study of 2 ED HCV screening programs. Patients who screened HCV antibody reactive between 1 May and 31 October 2014 were followed for up to 18 months. The main outcome was the absolute number and proportion of eligible patients who completed each stage of the HCV Continuum of Care.
  A total of 3704 ED patients were estimated to have undiagnosed HCV infection, and screening identified 532 (14.4%) HCV antibody-reactive patients. Of the 532 HCV antibody-reactive patients, 435 completed viral load testing (82%), of whom 301 (69%) were chronically infected. Of the 301 chronically infected patients, 158 had follow-up arranged (52%), of whom 97 attended their appointment (61%). Of these 97, 24 began treatment (25%), and 19 of these 24 achieved sustained virological response (79%).
  Urban EDs serve patients with poor access to preventive care services who have a high prevalence of HCV infection. Because ED patients identified with HCV infection can progress to treatment and cure with rates comparable to ambulatory care settings, implementation of ED HCV screening should be expanded.
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, and.|Department of Emergency Medicine, Stanford University, Palo Alto, California.|Northern Navajo Medical Center, Shiprock, New Mexico ; and Departments of.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Anderson
authors.affiliation: Emergency Medicine and.
authors.forename: James W
authors.initials: JW
authors.lastname: Galbraith
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, and.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Deering
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, and.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Pfeil
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, and.
authors.forename: Tamara
authors.initials: T
authors.lastname: Todorovic
authors.affiliation: Emergency Medicine and.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Rodgers
authors.affiliation: Emergency Medicine and.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Forsythe
authors.affiliation: Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Franco
authors.affiliation: Emergency Medicine and.
authors.forename: Henry
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Stanford University, Palo Alto, California.
authors.forename: N Ewen
authors.initials: NE
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, and.
authors.forename: Douglas A E
authors.initials: DAE
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003266:Continuity of Patient Care; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012189:Retrospective Studies; D000072230:Sustained Virologic Response
chemical_list: D018937:Hepatitis C Antibodies
keywords: continuum of care.; emergency department; hepatitis c virus; linkage to care; screening