Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Am J Emerg Med. 2023 Oct;72:178-182. doi: 10.1016/j.ajem.2023.07.050. Epub 2023 Jul 29.
The role of the Emergency Department (ED) as a vital constituent in Hepatitis C (HCV) screening has become increasingly evident. A key component of the ED's role in HCV screening is the ability to effectively link HCV-RNA positive patients to definitive, HCV-specific care, to include direct-acting antiviral (DAA) medication with resultant sustained virologic response (SVR). We sought to consider the rate of HCV-specific linkage, DAA initiation, and SVR obtained in HCV patients identified from an ED screening program.
A retrospective chart review was conducted in February of 2022 of all individuals who participated in an opt-out ED-based HCV screening program between January 2018 and December 2019. Data was disaggregated by race, gender, age/birth cohort, insurance status, and achievement of sustained virologic response (SVR). Bivariate analysis using Pearson's chi-square was utilized to compare outcomes based on insurance status, race, sex, and birth cohort.
Of 66,634 individuals screened for HCV during the study period, 885 (1.33%) patients were RNA-positive. Of those individuals, 121 (13.67%) were linked to HCV-specific care. Of those linked, the majority (66.9%) were male, white (66.1%; 33.1% Black), baby boomers or older (53.7%) and publicly insured (57.9%; private insurance 23.1%, self-pay 19%). Among linked patients, 88 (72.7%) started DAA medication. Mirroring linked demographics, majority were male (64.8%), white (64.8%), baby boomers or older (52.3%), and publicly insured (57.6%). White patients initiated on DAA were more likely to obtain SVR (64.9% versus 41.9% Black; p = .04) and uninsured patients were more likely to obtain SVR (82.4% versus 50.7% insured; p = .02). Bivariate consideration of SVR-patients specifically demonstrates that Black patients tended to be older, with significant overrepresentation of Baby boomers (77.5%) as compared to whites (37.5%; p < .0001). Black patients were also more likely to be publicly insured (82.5%) while white patients were more likely to have private insurance (28.8%) or be uninsured (26.3%) than their Black counterparts (12.5% and 5% respectively; p < .05).
An ED-based HCV screening program can result in successful HCV-specific linkage and care, to include DAA initiation and ultimately, SVR. Among linked patients, specific cohort considerations may demonstrate differences in age and insurance status which may have implications on DAA application and adherence, and therefore, individual ability to achieve SVR.
急诊科（ED）作为丙型肝炎（HCV）筛查的重要组成部分，其作用越来越明显。ED 在 HCV 筛查中的一个关键作用是能够有效地将 HCV-RNA 阳性患者与明确的 HCV 特异性护理联系起来，包括直接作用抗病毒（DAA）药物治疗，从而获得持续病毒学应答（SVR）。我们试图考虑从 ED 筛查计划中确定的 HCV 患者的 HCV 特异性联系、DAA 起始和 SVR 获得率。
2022 年 2 月，对 2018 年 1 月至 2019 年 12 月期间参加基于 ED 的 HCV 筛查计划的所有个体进行了回顾性图表审查。根据种族、性别、年龄/出生队列、保险状况和持续病毒学应答（SVR）获得情况对数据进行了细分。使用 Pearson's chi-square 进行了双变量分析，以根据保险状况、种族、性别和出生队列比较结果。
在研究期间，对 66634 名 HCV 进行了筛查，885 名（1.33%）患者 RNA 阳性。在这些患者中，121 名（13.67%）与 HCV 特异性护理联系。在联系的患者中，大多数（66.9%）是男性，白人（66.1%；33.1%黑人），婴儿潮一代或更老（53.7%），并获得公共保险（57.9%；私人保险 23.1%，自付 19%）。在联系的患者中，88 名（72.7%）开始使用 DAA 药物。与联系的患者人口统计学相似，大多数是男性（64.8%），白人（64.8%），婴儿潮一代或更老（52.3%），并获得公共保险（57.6%）。白人患者开始使用 DAA 药物更有可能获得 SVR（64.9%比黑人 41.9%；p=0.04），而未保险患者更有可能获得 SVR（82.4%比保险 50.7%；p=0.02）。对 SVR 患者的双变量考虑表明，黑人患者年龄较大，与白人相比，婴儿潮一代的代表性显著增加（77.5%比 37.5%；p<0.0001）。黑人患者也更有可能获得公共保险（82.5%），而白人患者更有可能拥有私人保险（28.8%）或没有保险（26.3%），而不是他们的黑人同龄人（分别为 12.5%和 5%；p<0.05）。
基于 ED 的 HCV 筛查计划可以成功实现 HCV 特异性联系和护理，包括 DAA 起始和最终获得 SVR。在联系的患者中，特定队列的考虑可能会显示年龄和保险状况的差异，这可能对 DAA 的应用和依从性产生影响，从而影响个人获得 SVR 的能力。
