Improving Hepatitis C Testing and Treatment Initiation in Hospital Settings

Overview

Hospital-led interventions significantly increase hepatitis C virus (HCV) antibody and RNA testing uptake and improve linkage to care compared to usual care. Automated opt-out antibody testing, reflex RNA testing, and care coordination with financial incentives showed the greatest effectiveness, though no single intervention improved all steps of the care cascade.

Background

Hepatitis C virus (HCV) elimination requires enhanced diagnosis, linkage to care, and treatment initiation, particularly in hospital settings where high-risk populations frequently present. Despite this, many patients in hospitals remain untested or untreated due to missed opportunities and barriers in care coordination. Hospitals represent critical points for intervention to improve testing uptake and treatment commencement, yet the most effective hospital-led strategies remain unclear. This systematic review and meta-analysis evaluates the impact of various hospital-based interventions on HCV care cascade outcomes.

Data Highlights

Key Findings

• Hospital-led interventions increased HCV antibody testing uptake with a pooled odds ratio (pOR) of 5.83.
• RNA testing uptake was significantly improved (pOR 10.65) by hospital interventions.
• Linkage to care showed moderate improvement (pOR 1.75) with interventions.
• Automated opt-out antibody testing had the highest impact on antibody testing uptake (pOR 16.13).
• Reflex RNA testing yielded the greatest increase in RNA testing uptake (pOR 25.04).
• Care coordination combined with financial incentives improved linkage to care (pOR 2.73).
• No single intervention improved all steps of the HCV care cascade including treatment initiation.

Clinical Implications

Implementing automated opt-out antibody testing and reflex RNA testing in hospital settings can substantially increase HCV diagnosis rates. However, to translate testing gains into treatment initiation, additional strategies such as care coordination and financial incentives are necessary to improve linkage to care. Hospitals should adopt multifaceted interventions tailored to each step of the HCV care cascade to optimize patient outcomes.

Conclusion

Hospital-led interventions effectively increase HCV testing uptake but have limited impact on treatment initiation, highlighting the need for comprehensive approaches to enhance linkage to care and treatment commencement. Future research should focus on developing and evaluating interventions that address all stages of the HCV care cascade within hospital settings.

References

1. Systematic Review and Meta-Analysis (2024) -- Improving Testing, Care Connection, and Treatment Initiation for Hepatitis C Virus in Hospital Settings