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BACKGROUND: An estimated 145,000 persons are chronically infected with hepatitis C (HCV) in New York City (NYC). Since 2000, positive HCV test results have been reportable to the NYC Department of Health. In July 2014, negative HCV RNA results became reportable by laboratories. We aim to use RNA results to identify patients who may have been treated, cured, or not had the recommended RNA testing.
METHODS: Routine surveillance reports are electronically imported into our database, and all results for each individual are automatically linked. We analyzed RNA results reported by hospital and commercial laboratories to the Health Department. We also identified patients newly reported with a positive antibody in 2014 and examined their RNA testing results.
RESULTS: Twenty-two laboratories routinely perform RNA testing for NYC residents. In mid-2014, we began assisting these laboratories in modifying their systems to report negative RNA results, prioritizing high-volume laboratories. By then end of 2014, 12 of 22 laboratories were reporting all negative RNA results. Based on historical data we estimate that these 12 laboratories account for 86% of HCV RNA tests citywide. From August 1, 2014 to December 31, 2014, we received 14,788 negative HCV RNA reports, representing 12,106 persons. We examined results for 6,492 patients newly-reported with a positive antibody in 2014 and found that 14% (877) had a negative RNA as their most recent result and were thus not infected, 38% were most recently RNA positive, and 48% had no reported RNA result.
CONCLUSIONS: Laboratory reporting of negative HCV RNA results is progressing well; we aim to have all 22 laboratories fully reporting negative results by early 2015. Even with only partial reporting to date, we are beginning to see the value of these data in helping us better describe testing patterns among persons reported with HCV. Of newly-reported patients, 877 were no longer HCV-infected, having either spontaneously resolved their infection or been cured, thus not requiring further follow up. Negative RNA results can be used to describe patterns of treatment and cure, but surveillance-based definitions must be validated. To that end, next steps include developing and validating definitions to categorize patients as treated and cured using surveillance data. Analyzing patterns of RNA results will be useful in identifying populations needing RNA testing and linkage to care, for monitoring real-life success with new treatments, and targeting healthcare facilities and geographic areas to improve HCV patient care.