Infectious Disease Week (IDWeek)
October 2-6, 2013
San Francisco, Ca
1756. Rapid Hepatitis C Virus Testing: An Innovative Pilot Study for Testing and Linking High Risk Populations from a Mobile Healthcare Clinic
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters IDSA.2013.#41989.Morano.pdf (1.4 MB)
Background: After recent release of effective HCV treatments, CDC guidelines aim to increase HCV testing and linkage to treatment for certain high-risk populations. This approach has not, however, been empirically tested using rapid HCV testing strategies.
Methods: An innovative rapid HCV testing campaign was deployed from a mobile medical clinic (MMC) in New Haven, CT using routine medical intake information. Clients could select rapid versus traditional phlebotomy testing. Traditional testing included phlebotomy for other medical co-morbidities, including syphilis, hepatitis B, and chronic medical conditions. Independent correlates of: 1) type of HCV testing strategy; and 2) reactive HCV antibody results were assessed. Linkage to HCV care was defined as completing one follow-up clinical visit in person with confirmatory HCV testing.
Results: All of 190 clients approached from March 2012 to March 2013 accepted HCV testing; 154 (81.1%) chose rapid HCV testing. Overall, 17 (8.9%) were HCV+, with 13 (8.4%) in the rapid and 4 (11.1%) in the traditional group. Generally, participants were mean age 35.9 years, previously incarcerated (51.1%), had >15 lifetime sexual partners (81.6%), were US-born (84.7%), had used illicit drugs (75.3%), and previously tattooed (64.2%). Of the 60 (31.6%) people who inject drugs (PWID), only 9 (15.0%) were within the “baby boomer” cohort.
Independent correlates of choosing rapid HCV testing over phlebotomy were non-PWID (AOR 25.0; p=0.027) and less than 15 lifetime sexual partners (marginal effect 0.17; p=0.003). Independent correlates of being HCV+ were being non-Hispanic White (AOR 15.2; p=0.002), reported sex with a known HCV+ partner (AOR 33.0; p<0.001), and increasing age (AOR 1.08; p=0.003). Among the 17 HCV+ patients, only 7 (53.8%) were within the “baby boomer” cohort, and 12 (70.6%) were successfully linked to HCV care.
Conclusion: The majority of individuals prefer rapid HCV testing, yet higher risk individuals opted for traditional phlebotomy testing, perhaps to identify other comorbid conditions. Rapid testing, however, identified the majority of new HCV infections, using an innovative MMC model which successfully engaged individuals who might otherwise not have been tested in traditional healthcare settings. Risk-based testing thus necessarily augments the “baby boomer” HCV screening age category.
Jamie Morano, MD, MPH1, Alexei Zelenev, PhD2, Andrea Lombard, RN, BSN, MPH, CIC3, Britton Gibson, MPH2, Ruthanne Marcus, MPH4 and Frederick Altice, MD5, (1)Department of Infectious Diseases, Yale University School of Medicine, Yale Clinical Research, Yale University AIDS Program, Center for Interdisciplinary Research on AIDS, New Haven, CT, (2)Yale University School of Medicine, Yale University AIDS Program, New Haven, CT, (3)Viral Hepatitis Section, Connecticut Department of Public Health, Hartford, CT, (4)Yale Clinical Research, Yale University AIDS Program, Yale School of Public Health, New Haven, CT, (5)Yale University School of Medicine, Yale School of Public Health, Director, Yale University AIDS Program, Yale Clinical and Community Research, Yale Center for Interdisciplinary Research on AIDS, New Haven, CT
Disclosures:
J. Morano, Vertex Pharmaceuticals Circle of Care Hepatitis C Grant: Grant Investigator, Research grant and Research support
A. Zelenev, None
A. Lombard, None
B. Gibson, Vertex Pharmaceuticals: Collaborator, Salary
R. Marcus, None
F. Altice, Vertex Pharmaceuticals Circle of Care Hepatitis C Grant: Investigator, Research grant and Supporting Mobile Clinic Work for HCV Testing; No Drug Support Given
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