Strategies to Increase Hepatitis C RNA Testing for Persons with a Positive Antibody Test Result

Brief Summary
Diagnosing hepatitis C (HCV) infection requires two tests, a screening antibody test followed by an RNA test. At the New York City Department of Health and Mental Hygiene (DOHMH), HCV surveillance data show that many patients with a positive antibody test do not receive the recommended RNA test to determine infection status. For the roundtable discussion, the presenter will describe strategies used at NYCDOHMH to increase HCV RNA testing. We will also hear about strategies in place at other health departments. HCV infection is a major public health issue. Recent increases in morbidity and mortality, along with improved antiviral treatments with much better cure rates, make HCV diagnosis and linkage to care a priority. In NYC, at least 1/3 of persons with a positive antibody test do not receive RNA testing. DOHMH is pursuing several strategies to increase RNA testing: 1)We mail educational booklets to all persons newly reported to the surveillance system. The booklet explains HCV tests, complications, transmission and antiviral treatment, and provides resources. For persons with no report of RNA testing, the cover letter advises patients to ask their clinician about the RNA test. 2) For each patient with a positive antibody test but no RNA result, we mail a letter to the ordering clinician, recommending they order the RNA test and including a copy of HCV testing guidelines. 3) We encourage laboratories to stress the importance of RNA testing when providing positive antibody results. 4) We educate clinicians on the availability of HCV reflex test, where the laboratory immediately performs the RNA test on the same specimen if the antibody result is positive. 5) We surveyed a sample of Federally Qualified Health Centers about HCV RNA testing practices, and provide technical assistance to improve RNA testing rates based on the results. 6) We discuss the issue at the Hep C Task Force (community advisory group) meetings to explore challenges and solutions to RNA testing in various settings (e.g., correctional facilities, drug treatment facilities). 7) We mailed a letter from NYC’s Commissioner of Health to over 35,000 clinicians, highlighting the need for RNA testing, along with other key updates on hepatitis C diagnosis and management. To evaluate these efforts, we are monitoring the proportion of patients with a positive antibody test who also have a positive RNA test reported to our surveillance system.