Clinical Scorecard: Improving Testing, Care Connection, and Treatment Initiation for Hepatitis C Virus in Hospital Settings: A Systematic Review and Meta-Analysis

At a Glance

Key Highlights

• Hospital-led interventions significantly increase HCV antibody testing uptake (pOR 5.83) and RNA testing uptake (pOR 10.65) compared to usual care.
• Automated opt-out antibody testing and reflex RNA testing show the greatest increases in testing uptake.
• Care coordination and financial incentives improve linkage to care but no intervention consistently increases uptake across all care cascade steps.

Guideline-Based Recommendations

Diagnosis

• Implement automated opt-out HCV antibody testing in hospital settings to increase testing rates.
• Use reflex RNA testing following positive antibody tests to confirm active infection efficiently.

Management

• Incorporate care coordination and financial incentives to enhance linkage to HCV care after diagnosis.
• Explore additional interventions to improve treatment initiation as current strategies have limited impact on this step.

Monitoring & Follow-up

• Track HCV testing uptake, linkage to care, and treatment initiation rates within hospital settings to evaluate intervention effectiveness.

Risks

• Missed opportunities for diagnosis and treatment occur when HCV testing is not routinely offered despite risk factors.
• Failure to link diagnosed patients to care and treatment limits the impact of testing interventions.

Patient & Prescribing Data

Hospitalized patients and those attending outpatient clinics or emergency departments with risk factors for HCV

Direct-acting antiviral (DAA) treatment initiation during hospitalization is uncommon; interventions increasing testing do not necessarily increase treatment uptake, indicating a need for focused linkage strategies.

Clinical Best Practices

• Adopt automated opt-out antibody testing protocols in hospital settings to maximize diagnosis rates.
• Utilize reflex RNA testing to streamline confirmation of active HCV infection.
• Implement care coordination programs and consider financial incentives to improve linkage to care.
• Recognize that multi-step interventions are needed as no single approach improves all steps of the HCV care cascade.
• Prioritize interventions targeting linkage to treatment after diagnosis to achieve HCV elimination goals.

References

• PRISMA Guidelines
• PROSPERO Registration CRD42019146569