The following is a summary of “Sustained virologic response from hepatitis C from an emergency department screening & linkage program: A retrospective review,” published in the October 2023 issue of Emergency Medicine by Walter, et al.

The Emergency Department (ED) plays a crucial role in Hepatitis C (HCV) screening, with a key focus on effectively connecting HCV-RNA-positive patients to specialized care, including direct-acting antiviral (DAA) medication leading to sustained virologic response (SVR). For a study, researchers sought to explore the outcomes of HCV patients identified through an ED screening program, emphasizing HCV-specific linkage, DAA initiation, and SVR.

A retrospective chart review conducted in February 2022 analyzed individuals participating in an opt-out ED-based HCV screening program from January 2018 to December 2019. Data was categorized by race (66.1% white, 33.1% Black), gender (66.9% male), age/birth cohort (53.7% baby boomers or older), insurance status (57.9% publicly insured, 23.1% privately insured, 19% self-pay), and SVR achievement. Bivariate analysis compared outcomes based on insurance status, race, sex, and birth cohort.

Out of 66,634 individuals screened for Hepatitis C (HCV) during the study period, 885 (1.33%) were RNA-positive. About 121 (13.67%) of these individuals were successfully linked to HCV-specific care. Among the linked patients, a majority (66.9%) were male, 66.1% were white (with 33.1% being Black), 53.7% belonged to the baby boomer age group or older, and 57.9% had public insurance (23.1% had private insurance, and 19% were self-pay). Within the linked cohort, 88 individuals (72.7%) initiated direct-acting antiviral (DAA) medication. This mirrored the demographics of the linked group, with a majority being male (64.8%), white (64.8%), belonging to the baby boomer age group or older (52.3%), and having public insurance (57.6%). In terms of DAA initiation, white patients were more likely to achieve sustained virologic response (SVR) (64.9%) compared to Black patients (41.9%; P= .04), and uninsured patients were more likely to obtain SVR (82.4%) compared to insured patients (50.7%; P = .02). A bivariate analysis focusing on SVR patients specifically revealed that Black patients tended to be older, with a significant overrepresentation of Baby boomers (77.5%) compared to whites (37.5%; P < .0001). Additionally, Black patients were more likely to be publicly insured (82.5%). In comparison, white patients were more likely to have private insurance (28.8%) or be uninsured (26.3%) compared to their Black counterparts (12.5% and 5%, respectively; P < .05).

An ED-based HCV screening program facilitates HCV-specific linkage, DAA initiation, and SVR. Cohort-specific considerations, including age and insurance status, may influence DAA application, adherence, and the ability to achieve SVR.

Source: sciencedirect.com/science/article/abs/pii/S0735675723004096