METHODS: Five healthcare organizations identified patients screened prior or during baseline (10/1/2013-9/30/2014) and Year 1 (10/1/2014-9/30/2015). We collected laboratory and clinic data with patient identifiers for all HCV AB+ patients; we also collected limited de-identified data for patients in the birth cohort who were HCV AB- and those who were never tested for HCV. Laboratory and clinic visit data from four of five healthcare organizations that provided complete data were analyzed to assess screening and HCV status during baseline and Year 1.
RESULTS: Screening increased by 0.3% from baseline (n=39,786/252,389;[15.8%]) to Year 1 (n=40,958/254,405;[16.1%]) (p=0.0011), but HCV AB+ detection was similar in the baseline and year 1 periods (11.9% vs. 12.0%, p=0.4597). More males were screened than females (52%, p<0.0001) during both time periods. Chronic HCV was confirmed in 11,868 patients in baseline and Year 1; 65% belonged to the birth cohort, 59% were male, and 13% were uninsured. Although most cases were White (57%), Blacks (18%) accounted for a higher proportion of cases relative to their distribution in the 2014 King County population (7%). One-third of chronic HCV patients were genotyped. Co-morbidities included hepatitis B (16%), HIV (7%), cirrhosis (16%), and renal dialysis (7%).
CONCLUSIONS: The burden of chronic HCV in King County is significant; disparities in the racial distribution of cases were observed. Screening estimates, which increased marginally from baseline to Year 1, are likely higher as restriction to primary care clinics wasn’t available at time of analysis. The distribution of patients along the HCV care cascade, including staging, treatment utilization, and cure, will be completed by spring 2016, when data quality improvements are addressed in Year 2 of the program.