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BACKGROUND:
The presence of HCV antibody confirms that an individual was exposed to HCV at some point in their lifetime, but cannot distinguish between past or present infection. Additional nucleic acid testing (NAT) is required to determine true infectious status. Finally, for those actively infected with HCV, genotyping of the virus indicates evaluation for HCV therapy. Patients must progress through each “round” of testing for HCV treatment and to ultimately clear their infection. However, studies have shown that many patients do not progress through the HCV testing cascade. This study uses routine surveillance data reported to the Michigan Disease Surveillance System (MDSS) in 2014, to evaluate the proportion of persons who received subsequent HCV testing.
METHODS:
Cases of HCV reported to the MDSS in 2014 were exported. Individuals with an initial HCV antibody test were examined for subsequent HCV NAT and genotype testing. Differences in the proportion of persons receiving follow-up testing were stratified by sex, race, and report of clients having a provider for hepatitis. A binomial t-test was used to compare differences in proportions.
RESULTS:
Of 8,232 cases of HCV, 5,956 were reported with an initial HCV antibody test. Of those 2,231 (37.5%) reported a HCV NAT and only 682 (6.4%) had a genotype result. Among Caucasians, there were 3,145 HCV antibody tests, 1,394 (44.3%) cases with a HCV NAT, and 447 (14.2%) genotypes compared to 1,151 HCV antibody tests, 338 (29.4%) NATs, and 84 (7.3%) genotypes for African-Americans. The proportion of Caucasians receiving NAT and genotype testing compared to African Americans was statistically significant (p<0.05).
CONCLUSIONS:
Here we demonstrate the use of routine surveillance data to evaluate the first steps in the HCV treatment cascade. The data show that most individuals who test positive for HCV antibody are often not receiving follow-up testing to confirm chronic infection. Even fewer are having their virus genotyped, signaling that only a fraction of those testing positive for HCV antibody in 2014 have been evaluated for treatment. There are also clear racial disparities in the data as Caucasians were much more likely than African-Americans to have received HCV nucleic acid and genotype testing. These data show the substantial unmet need for people diagnosed with HCV, likely related to access to care and provider knowledge. This information will be useful to share with clinical and public health partners for the purpose of designing, initiating, and evaluating public health prevention and intervention programs.