Assessing Gaps in Hepatitis C Care in Primary Care

BACKGROUND: Prevention of Hepatitis C virus (HCV) infection and its associated health complications are a national priority. To achieve optimal health outcomes, people with HCV must receive the diagnosis, link to and retain in care and receive treatment. Despite recent progress in increasing capacity and improving access to care for patients with HCV in the United States, there continues to be a need to improve Hepatitis C care especially in primary care settings. This study sought to assess HCV care in a resident-run primary care clinic of a community hospital. METHODS: Retrospective study of active patients ≥18 years with a diagnosis of Hepatitis C in the electronic medical records (EMR) at 2 outpatient medicine clinics at a community hospital in Rhode Island. Patients were identified by searching the following diagnoses in the EMR: “chronic hepatitis C”, “chronic hepatitis C without coma,” “chronic hepatitis C with coma,” “reactive HCV serology,” “hepatocellular carcinoma.” Patients with HIV coinfection were excluded as these patients are usually referred to a specialty clinic outside the hospital’s network. RESULTS: Of 12,482 outpatients, 306 had a diagnosis of Hepatitis C. One hundred and fifty-nine (54%) of these patients had HCV RNA detected indicating chronic infection, 51 (17%) patients had reactive HCV antibodies and undetected HCV RNA indicating past infection, and 84 (29%) patients had positive serology to HCV but lacked HCV RNA testing. Obesity was associated with not having HCV RNA checked (OR 2.9, 95% CI 1.66-5.24). No differences observed for other variables although patients with a history of alcohol use had a tendency towards lacking HCV RNA testing (P = 0.08). The prevalence of confirmed chronic hepatitis C was 1.6%. Twenty-three (21%) patients with chronic hepatitis C had cirrhosis and 5 had hepatocellular carcinoma however only a minority of them (11%) had received or were receiving direct acting antivirals. Hepatitis B vaccination in HCV infected patients was low (39%). CONCLUSION: A significant proportion of patients with reactive serology to HCV in our primary care clinics miss the critical step of having HCV RNA checked. Other medical conditions such as obesity may take priority over HCV care. Implementation of HCV targeted interventions could improve HCV care in primary care. DISCLOSURES: All authors: No reported disclosures.