Managing Hepatitis C in Vermont Module 2: Screening for HCV

Welcome to the Screening for HCV module Please take this brief pre-module quiz Click here for brief pre-module quiz or use this web address: https://forms.gle/HxU79ZQFsFzdJ5Gy5

This module works a lot better in “presentation” mode Above, go to “Slide Show” then hit “From Beginning” and click-through

Screening for HCV: Outline Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm

Screening for HCV: Outline Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm

Why screen for HCV? Identification of hepatitis C infected individuals allows linkage to curative treatment, which has two benefits: Benefit to the patient: Benefit to public health: Reduction in long term complications of decompensated cirrhosis and hepatocellular carcinoma Reduction in the pool of HCV infected persons and consequent reduction in disease transmission

Screening for HCV: Outline Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm

Who should be screened for HCV Anyone with any of the following: Born between 1945-1965 History of injection drug use History of incarceration Received clotting factors before 1987 Received blood transfusion or organ donation before 1992 Children of HCV-infected mothers History of needle stick injury History of sex with HCV-infected person (in particular men who have sex with men) Evidence of liver disease or abnormal serum aminotransferase levels Hemodialysis HIV

Screening for HCV in the US: improvement sorely needed 0.6M on HCV therapy 3 million have +HCV RNA 4 million have +HCV antibody 80 million fit screening criteria Screening includes birth cohort and those at increased risk based on lifestyle factors

Screening for HCV: multiple breaks in chain from diagnosis to cure In one study from Denver Health… More testing and better linkage to HCV care needed Inadequate screening Inadequate HCV RNA testing Numbers of patients Inadequate treatment or referral Rowan SE, Durfee J, Tabano DC, et al. The association between HCV and comorbid conditions in 2 large patient cohorts. CROI, February 13-16, 2017, Seattle. #528

Screening for HCV: Outline Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm

Addressing barriers to screening in VT Community awareness programs in at-risk populations Reducing the stigma of hepatitis C through public health campaigns Improving outreach of point-of-care testing beyond medical offices Automated reminders for primary health professionals Particularly for the “Baby Boomer” cohort, born between 1945 and 1965

Screening for HCV: Outline Why screen Whom to screen Addressing barriers to screening How to screen: HCV testing algorithm

Test serum hepatitis C (HCV) antibody (Ab) in the following groups Anyone with any of the following: Born between 1945-1965 History of injection drug use History of incarceration Received clotting factors before 1987 Received blood transfusion or organ donation before 1992 Children of HCV-infected mothers History of needle stick injury History of sex with HCV-infected person (in particular men who have sex with men) Evidence of liver disease or abnormal serum aminotransferase levels Hemodialysis HIV HCV Ab positive Indicates HCV exposure HCV Ab negative HCV RNA not detected Naturally cleared HCV infection or previously treated Repeat HCV RNA in future if ongoing risk Check serum HCV RNA Indicates no HCV exposure. Repeat HCV Ab in future if ongoing risk HCV RNA detected Active HCV infection See Module 3

Screening for HCV: Key Points Many patients in the USA and Vermont are unaware they have chronic HCV infection Screening benefits both them and reduces further transmission Screening efforts have lagged behind need. Targeted screening of high- risk groups is essential An HCV antibody is the standard screen, and is confirmed with an HCV RNA viral load Patients who have naturally or medically cured HCV will always have a positive HCV antibody and should be re-screened with an HCV RNA viral load Next Step: Module 3: The Post Screening Process

Congratulations! Please take the post-module quiz here Click here for brief post-module quiz or use this web address: https://forms.gle/BSHj3Gi2YV6wvEAz5