1 Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
2 Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
3 Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA; Section of Infectious Diseases, St. Mary's Hospital - Trinity Health of New England, Waterbury, Connecticut.
4 Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Joseph.Canterino@yale.edu.
BACKGROUND: There is an urgent need to increase patient access to treatment of chronic Hepatitis C infection. We developed a co-localized Hepatitis C clinic integrated within a primary care practice. We report the Hepatitis Cprevalence and evaluate the impact of the integrated clinic on the Hepatitis C cascade of care.
METHODS: We performed a retrospective study of patients with chronic Hepatitis C infection from two clinic practices, the integrated clinic practice and a similar non-integrated clinic practice between July 2015 and July 2016. Demographic, clinical, and Hepatitis C testing data were reviewed to estimate the prevalence of chronic Hepatitis Cand to construct a cascade of care.
RESULTS: A total of 8,405 primary care patients were included; 4,796 (57.1%) received a HCV antibody test and 390 (8.1%) were positive. There were 310 patients with chronic Hepatitis C included in the analysis. There were 119 patients eligible for linkage to care in the non-integrated clinic, of which 80 (67.2%) were referred, 38 (31.9%) were linked, and 18 (15.1%) initiated treatment during the study period. Among the 70 patients eligible for linkage to care in the integrated clinic practice, 51 (72.9%) were referred, 38 (54.3%) were linked, and 16 (22.9%) initiated treatment. In a multivariable analysis, patients in the integrated clinic practice had significantly higher odds of being linked to care than patients in the non-integrated clinic practice (adjusted OR 2.5, 95% CI=1.3 - 4.8).
CONCLUSIONS: We found a high seroprevalence of chronic Hepatitis C within our clinic population and demonstrate that a Hepatitis C clinic integrated into a primary care center increases linkage to care for patients with chronic Hepatitis C.