BACKGROUND: In 2013, the Philadelphia Department of Public Health (PDPH) published an assessment of the hepatitis C virus (HCV) continuum of care (CoC) using 2010 – 2013 city-level data. Since then, PDPH’s Viral Hepatitis Program has worked with providers, reference laboratories, and community partners to improve HCV testing, reporting, and linkage to care services throughout Philadelphia. With improved surveillance, increased use of direct acting antivirals (DAAs), and revised insurance restrictions, more patients are being treated and cured of HCV than ever before. The purpose of this analysis is to provide an updated version of Philadelphia’s HCV CoC to assess improvements and gaps at each stage.
METHODS: This study used HCV surveillance data from 2010 to 2016. HCV CoC stages were defined as: Stage One - HCV Antibody (Ab) screening, Stage Two - HCV Ab screening and RNA testing, Stage Three - RNA testing with evidence of medical care, and Stage Four - RNA testing with evidence of medical care and treatment initiation. Differences between 2010 – 2013 (1st CoC) and 2014 – 2016 (2ndCoC) were assessed. Chi-square analysis was used to compare differences in the demographic and risk factor profiles of HCV RNA-positive individuals who have and have not received treatment.
RESULTS: During 2010 - 2016, it was estimated that 3% (N = 53,000) of Philadelphia residents were living with HCV, and ~40,000 individuals should have received an HCV test. In the 1st CoC, 34% (13,596) were Ab screened (Stage One) and 16% were RNA tested (Stage Two), while in the 2nd CoC, 47% (N=18,801) were Ab screened (Stage One) and 38% were RNA tested (Stage Two). Few of the individuals in both CoC were in care (4% and 6% for the 1st and 2nd CoC, respectively) and fewer still had received treatment (2% and 4% for the 1st and 2ndCoC, respectively). Individuals with treatment history (Stage Four) were significantly more likely to be ≥31 years of age, have no history of incarceration or injection drug use, and have private insurance coverage.
CONCLUSIONS: Our study highlights improvements along the HCV CoC, most significantly at Stages One and Two, Ab screening and RNA confirmation. However, challenges remain in mobilizing HCV RNA confirmed patients into care and treatment. Moreover, our findings show evidence that treatment barriers disproportionately exist for the most at-risk populations. More work is needed to develop best practices for engaging HCV positive individuals through the entire HCV CoC.