Article Title

Hepatitis C Virus Infection and Increasing Screening and Linkage to Care in a Large Integrated Health System

Publication Date



hepatitis C, epidemiology


Background/Aims: With increased national focus on diagnosing and linking patients to care or treatment, we describe trends in hepatitis C virus (HCV) screening and linkage to care in the Kaiser Permanente Mid-Atlantic States health system, particularly among those born between 1945 and 1965 (birth cohort). We observed 665,345 adults enrolled in Kaiser Permanente Mid-Atlantic States from 2003 to 2015.

Methods: We used survival methods to describe factors associated with time to antibody and confirmatory (RNA/genotype) testing. Logistic regression was used to describe odds of HCV infection and gastroenterology/infectious disease visit or treatment (linkage).

Results: The annual screening rate increased steadily from 23.6 to 70.8 per 1,000 person-years, with the sharpest increase after 2013. Overall, 19% (123,572 of 665,345) were screened for HCV. Screening among the birth cohort was lower than among noncohort members. However, the gap shrank in later years of study. Significant positive predictors of screening included drug use, hepatitis B and human immunodeficiency virus (HIV) status, female sex, living in lower-income areas and elevated alanine aminotransferase (ALT). Among antibody-positive adults, 86% (3,643 of 4,242) received confirmatory testing. A prior gastroenterology/infectious disease visit and being seen in Baltimore clinics were associated with increased rates of confirmatory testing. We identified 3,310 with chronic HCV by RNA or genotype (2.7% of the 124,841 persons ever antibody-tested, RNA-tested or genotyped). Blacks, birth cohort members, males, those with history of illicit drug use and those with elevated ALT were associated with higher odds of HCV infection. Hispanics, patients with HIV or hepatitis B, and those from higher-income areas were at lower risk. Among patients with chronic HCV, 86% (2,844 of 3,310) were linked to care. Predictors of linkage include elevated ALT, HIV status and black or Hispanic race.

Conclusion: We report higher rates of HCV screening, confirmatory testing and linkage compared to similar cohorts. Although HCV screening is still predominantly risk-based, birth cohort screening is increasing in concert with national guidelines. Our data support other studies that suggest that sexual intercourse, even among men who have sex with men, is not a primary means of HCV transmission, and that risk of HCV is higher in low-income areas. These data provide important parameters from which to base and compare future interventions to increase screening, care and treatment.




June 27th, 2016


August 12th, 2016