BACKGROUND: Hepatitis C (HCV) infection results in significant morbidity and mortality. In 2015, 2,860 cases of HCV were reported in Baltimore City. Until recently, treatment for HCV was largely ineffective and associated with debilitating side effects. Many individuals with HCV infection have not received treatment and have fallen out of regular care.
METHODS: A linkage-to-care (LTC) program was developed to identify persons with chronic HCV infection not receiving HCV care, resolve barriers to care, and link them to HCV providers. Maryland’s National Electronic Disease Surveillance System (NEDSS) was used to identify reported cases of HCV in Baltimore City between July 1, 2014 and November 30, 2015. Ordering information for HCV diagnostic tests was used to follow up with providers and determine if individuals were receiving HCV care. Examples of out-of-care determination included: no clinical follow-up after initial diagnosis, not seen in the last 6 months, prescribed treatment but never followed up, and treated but never returned for post-treatment labs. Providers in Baltimore City were also encouraged to contact the Baltimore City Health Department regarding individuals in need of re-engagement assistance. Field follow-up was undertaken for all individuals believed to be out-of-care. Once confirmed out-of-care, LTC staff provided assistance with scheduling appointments, transportation, and incentives for attending appointments. While support was provided for two appointments, attending one appointment was considered successful linkage to care.
RESULTS: 7,774 individuals with HCV reports were identified through NEDSS between July 1, 2014 and November 30, 2015. From November 11, 2015 until September 30, 2016, the providers of 4,298 individuals were contacted to determine HCV care status. Of those, 485 were potentially out-of-care and in need of field follow-up. Additionally, HCV providers independently initiated investigations for 87 individuals in need of re-engagement assistance. Of the 551 investigations completed to date, 213 (38.7%) have been successfully linked to care, 146 (26.5%) could not be located, 114 (20.7%) were found to already be in care, 51 (9.3%) refused assistance, 16 (2.9%) were deceased, and 11 (2.1%) no longer live in Baltimore City.
CONCLUSIONS: This pilot program illustrates successful use of HCV surveillance data for public health action and has resulted in a significant number of HCV-infected Baltimore City residents being connected to essential HCV care and treatment. This surveillance-initiated outreach will be critical as the public health community moves toward HCV elimination and emphasizes the importance of public-private partnerships to enhance reporting and utilization of HCV surveillance data.