1Philadelphia Department of Public Health, Philadelphia, PA.
A Hepatitis C virus (HCV) infected person will ideally have access to quality health care and move through the HCV care continuum(CoC) from HCV antibody (Ab) screening, HCV RNA confirmation, engagement and retention in medical care, and treatment. Unfortunately, studies show that many patients do not progress through this continuum. Because these studies may not be generalizable, we assessed the HCV-CoC in Philadelphia from January 2010 to December 2013 at the population level. The expected HCV seroprevalence in Philadelphia during 2010-2013 was calculated by applying NHANES prevalences to age-specific census data approximations and published estimates of homeless and incarcerated populations. HCV laboratory results reported to the Philadelphia Department of Public Health and enhanced surveillance data were used to determine where individuals fell on the continuum. The HCV-CoC was defined as follows: Stage 1- HCV Ab screening; Stage 2 - HCV Ab and RNA testing; Stage 3 - RNA-confirmation and continuing care; Stage 4 - RNA-confirmation, care, and HCV treatment. Of approximately 1,584,848 Philadelphia residents, 47,207 (2.9%) were estimated to have HCV. Positive HCV results were received for 13,596 individuals, of whom 6,383 (47%) had a positive HCV RNA test. Of these, 1,745 (27%) were in care and 956 (15%) had or were currently receiving treatment. Conclusion: This continuum provides a 'real-life' snapshot of how this disease is being managed in a major US urban center. Many patients are lost at each stage, highlighting the need to raise awareness among health care professionals and at-risk populations about appropriate hepatitis testing, referral, support, and care.