S2737 The Impact of Language Discordance Between Primary Care Providers and Patients on Hepatitis C Follow-Up After Positive Screening: A Multi-Center Analysis

Introduction: Timely follow-up after a positive Hepatitis C virus (HCV) antibody test is essential for diagnosis confirmation via HCV RNA testing and initiation of treatment. Language discordance between patients and primary care providers (PCPs) may act as a barrier to appropriate follow-up. This multi-center study examines the association between patient-provider language discordance and follow-up rates with hepatology and/or gastroenterology specialists after a positive HCV antibody test. Methods: We conducted a retrospective chart review across 3 urban primary care clinics from 2022 to 2024. The study cohort included 317 patients aged 45–70 with first-time positive HCV antibody screening and private or public insurance. Patients were categorized based on language concordance with their PCP (English vs non-English primary language). Exclusion criteria included prior known HCV diagnosis, loss to follow-up due to death, incarceration, or relocation. Outcomes measured were: 1) completion of confirmatory HCV RNA testing, 2) attendance at specialist follow-up within 6 months, and 3) time to specialist follow-up. Data were gathered from electronic health records, specialist reports, and patient follow-up calls. Results: Of the 317 patients with a positive HCV antibody screen, 201 (63.4%) had language-concordant PCPs and 116 (36.6%) had language-discordant PCPs. HCV RNA confirmatory testing was completed in 88% of the concordant group versus 70% in the discordant group (P < 0.001). Among those with positive RNA, 76% (96/126) of language-concordant patients saw a specialist within 6 months, compared to 58% (39/67) of language-discordant patients (P < 0.001), yielding an adjusted odds ratio of 2.3 (95% CI: 1.4–3.9). Median time to specialist visit was shorter in the concordant group (45 days, IQR: 31–60) than the discordant group (58 days, IQR: 44–76; P < 0.001). Differences were more pronounced in Medicaid patients (concordant 72% vs discordant 49%, P < 0.001) than those with private insurance (concordant 81% vs discordant 75%, P = 0.11). Conclusion: Language concordance between PCPs and patients was significantly associated with higher rates of confirmatory testing and specialist follow-up after a positive HCV screen. Disparities were amplified in publicly insured populations, suggesting that language barriers may compound systemic access limitations. Targeted communication interventions are critical for improving equity in HCV care.