S2670 Screening Location and Success of HCV Linkage to Care and Treatment

Introduction: While hepatitis C virus (HCV) is a major cause of morbidity and mortality in the United States, it is now a curable infection with direct acting antiviral (DAA) medications. Yet despite efforts at our large tertiary academic health system, we struggle to implement care delivery pathways to achieve HCV elimination. Our study aims to characterize our institution’s HCV-positive population in order to identify relationships between screening setting and receipt of subsequent care. Methods: This was a retrospective observational cross-sectional study from a large academic healthcare system. We queried the electronic medical record for patients >18 years old who received HCV screening (i.e. antibody test) between April 1, 2021 and April 1, 2025. Data variables included initial and subsequent testing locations, engagement with care and treatment after screening. Cleared/treated infection was defined as viral load <15 (IU/mL) any time after initial positive PCR. Results: Overall, 137,101 individuals received HCV screening within our medical system, of which 2,038 had a positive viral load. Of 1,322 viremic patients with a documented ordering location, 29.6% (n = 391) were first screened during a hospital admission, 23.1% (n = 305) during an emergency department (ED) visit, and 46.6% (n = 626) in an outpatient context. Patients who received screening during an admission or ED visit were significantly less likely to have been prescribed DAAs (20.2% [79/391] vs 14.4% [44/305] vs 52.6% [329/626] for admission, ED visit, and outpatient, respectively, P < 0.0001) and to clear infection (12.0% [47/391] vs 9.2% [28/305] vs 43.0% [269/626] for admission, ED visit, and outpatient, respectively, P < 0.0001). Patients with housing insecurity were also significantly less likely to clear infection (19.0% [138/725] vs 23.6% [310/1313] , P = 0.0197). 66.2% (202/305) of patients screened in the ED and 60.9% (238/391) of patients screened during admission received no further HCV PCR testing. However, 52% (229/440) of those patients had a subsequent ED visit or admission. Conclusion: Approximately half of patients diagnosed with HCV received screening in the ED or during a hospital admission. These patients were significantly less likely to have been prescribed DAAs, and therefore, less likely to clear infection; they also had lower rates of follow up. This suggests ED visits and hospital admissions are crucial settings for HCV management. Future interventions will focus on increasing DAA prescribing in these environments.