Abstract Body

Background: With rapid improvements in the efficacy and safety of hepatitis C treatments, the factors that will determine net treatment effectiveness are the rates of testing of high risk populations and linkage to care. Rapid hepatitis C tests have been demonstrated to be accurate in diagnosis of hepatitis C. Their impact on receipt of hepatitis C antibody results in public health settings such as sexually transmitted disease (STD) clinics is not known. Methodology: Rapid hepatitis C antibody testing was implemented and routinely offered to all STD clinic attendees at the Baltimore City Health Department (BCHD) Druid STD clinic starting in June 2013. Prior to this, risk-based hepatitis C testing with a standard laboratory based ELISA, was offered at the BCHD STD clinics. We compared the rates of documented hepatitis C posttest counseling and linkage to care of those tested by the rapid method to those tested with the standard of care, ascertained by review of electronic medical records. Written documentation of provision of hepatitis C antibody results was available for patients who received rapid testing. For those who received the standard of care, failure to return to the STD clinic 6 months after laboratory hepatitis C antibody testing was considered lack of receipt of results. Results: Prior to implementation of the rapid test, 767 individuals (65.5 male) received a standard hepatitis C ELISA, which requires 7 days for results to be available, between January 1, 2012 and December 30, 2012. From June 24, 2013 to September 30, 2013, 1,478 individuals were offered the rapid hepatitis C test with results available in 20 minutes, of whom 1163 (79%) accepted and received rapid hepatitis C testing. 59.5% of rapid tested patients were male. Patients receiving standard of care hepatitis C testing were on average older than rapid hepatitis C tested patients: median age (IQR); 34 (25-47) years and 28 (24-39) years respectively. Out of 137 individuals with positive hepatitis C antibody test results from the standard of care, 90 (67%) individuals received their hepatitis C antibody results. In contrast, 72 (100%) of 72 hepatitis C antibody positive individuals from the rapid tested patients received their hepatitis C antibody results, alcohol screening and posttest counseling on the day of rapid testing; p-value <0.001. Additionally for individuals found to be hepatitis C antibody positive on rapid testing, 69 (96%) of 72 had blood drawn for follow up hepatitis C RNA testing on the day of rapid hepatitis C testing. Conclusions: Implementation of rapid hepatitis C tests has the potential to dramatically reduce loss to follow up and facilitate early linkages to hepatitis C care.