The Rest of the Story: Making Negative Hepatitis C Virus RNA Test Results Reportable As Part of Routine Surveillance

Brief Summary
Hepatitis c virus (HCV) infection is a major public health issue. Recent increases in morbidity and mortality, along with improved antiviral treatments with better cure rates, make HCV diagnosis and linkage to care a public health priority. To our knowledge, only positive HCV test results are currently reportable as part of routine disease surveillance activities in most of the US. If a screening antibody test is positive, and a follow-up RNA test is negative, a health department would not learn of the negative RNA results without labor-intensive case investigation. Adding negative HCV RNA test results to reporting requirements for Electronic Laboratory Reporting could make routine surveillance more useful for monitoring HCV care and treatment. For the roundtable, Massachusetts (MA) and New York City (NYC) presenters will describe and discuss strategies, barriers and processes in making negative HCV RNA reportable. NYC and MA began by surveying labs to estimate the annual number of negative RNA test results in their jurisdictions. NYC projected that adding negative HCV RNAs would increase overall annual volume of reported HCV tests by 59% (from 107,000 to 170,000).   Specific to HCV RNA results, MA projected an increase of 21% (from 4,700 to 5,700 annually). Both jurisdictions decided to only import negative RNA results into surveillance databases for persons with a previous positive HCV test. Therefore, new matching processes are being developed. Both MA and NYC are modifying their health code/regulations to mandate laboratories (not providers) report negative HCV RNA results. We will also discuss ways that negative HCV RNA results can be used, including i) identifying patients who have had a positive HCV antibody test but have not yet had the recommended HCV RNA test to determine infection status; ii) assessing patterns of RNA test results (positive and negative) to identify patients who are likely on antiviral treatment; and iii) assessing treatment success (i.e., sustained viral response, defined as negative HCV RNA test 6 months after the end of therapy). Examining these metrics by patient demographics, geographic areas, and provider characteristics can identify disparities and aid in developing outreach activities to improve HCV care and treatment, thereby improving health outcomes. Health department staff resources are needed to carry out all these activities.