Barriers to Successful Linkage to Care Among HCV Positive Individuals Presenting to a Major Tertiary Medical Center on Long Island, New York

Abstract Background In 2013, the US Preventive Services Task Force made a grade B recommendation to offer HCV screening for at-risk individuals and baby boomers (born between 1945 and 1965). However, only 50% of HCV-positive individuals are aware they are infected, and far fewer attend an outpatient appointment and are initiated on treatment (Linkage to Care: LTC). The aim of this study is to assess the factors affecting LTC among HCV positives in a suburban tertiary medical center on Long Island, NY. Methods A retrospective chart review was performed on all patients with ICD-9 or 10 diagnostic codes for HCV positive antibody from January 2016 to March 2017 at Stony Brook University Hospital. Data were collected for HCV RNA, LTC, demographics, insurance and employment status, psychiatric diagnosis, comorbid medical conditions, substance use disorder, injection drug use, liver and kidney function, level of fibrosis. Results A total of 155 cases (61.9% male; mean age 53.9 years) had a positive HCV antibody, 110 (71%) had a follow-up HCV RNA test and 35.1% were LTC. The comorbidities present in this cohort were psychiatric disease (54.9%), cirrhosis (22.6%), HBV infection (14.1%) and HIV (8.5%). In the univariate analysis, new inpatient HCV diagnosis (OR = 0.09, 95% CI: 0.02–0.36, P = 0.001), employment (OR = 3, 95% CI: 1.01–8.95, P = 0.049) and history of substance use disorder (OR = 0.38, 95% CI: 0.15–0.96, P = 0.043) were associated with LTC. In the logistic regression analysis, inpatient HCV diagnosis was negatively correlated with LTC (OR: 0.03, 95% CI: 0.002–0.41, P = 0.009). Two hot spots of HCV infection were identified in south central Suffolk County. Conclusion In this population, new inpatient HCV diagnosis and history of substance use disorder were less likely to have LTC, whereas those employed were more likely to have LTC. Innovative interventions in the inpatient setting may be beneficial for newly diagnosed HCV cases to improve LTC after discharge. Disclosures All authors: No reported disclosures.