Abstract

Objectives: Hepatitis C virus (HCV) is the most common bloodborne infection in the United States and a leading cause of liver-related morbidity. Tennessee is among the top 10 states for a patient population living with HCV, and it is especially prevalent in the Appalachian counties. The purpose of this study was to report single-center findings for HCV during a 30-month period from January 2022 to August 2024 at a rural safety-net clinic in eastern Tennessee with a patient population notable for a high prevalence of previous incarceration, injection/intranasal drug use, and/or being unhoused. The aim of this project was to identify factors in the clinical pipeline for HCV testing and treatment that can be improved to increase completion of HCV curative treatment.

Methods: Patients were offered confidential HCV antibody screening with OraSure rapid HCV antibody tests using a fingerstick blood sample at the clinic, followed by confirmatory HCV RNA and human immunodeficiency virus assay at the local health department. Hepatitis B virus status was established at the clinic before the initiation of treatment. Aspartate aminotransferase-to-platelet ratio (APRI) and Fibrosis-4 index (FIB-4) scores were used to assess the progression of liver disease in HCV patients. Patients with active infection were treated with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir for 8 or 12 weeks, respectively. Demographic data were collected on all patients. Antibody-positive patients were assessed for whether they received confirmatory RNA testing, followed up on their results, and if they tested positive, began treatment, completed therapy, and were cured posttherapy.

Results: There were 231 screening antibody tests performed, 30 (12.9%) of which were positive. Twenty-five patients received confirmatory testing, 18 of whom were RNA positive. Of the RNA-positive patients, 12 followed up on their results, 11 began therapy, and seven completed therapy, all of whom were confirmed cured. Thirty-eight percent of all RNA-positive patients were definitively cured. Twenty-seven patients had FIB-4 and APRI scores available; eight FIB-4 and eight APRI scores were predictive of cirrhosis. Previous hepatitis B virus infection was found in five antibody-positive patients, and no human immunodeficiency virus was found. Patients were demographically consistent with the county of testing.

Conclusions: The overall antibody-positivity rate was not significantly different from previous reports of safety-net clinics in eastern Tennessee. Rates of follow-up, therapy, completion of therapy, and confirmation of cure were high in those patients who received confirmatory testing; however, 10% of antibody-positive patients were lost to follow-up before confirmatory testing. This suggests that if confirmatory HCV laboratory values could be obtained at the time of the positive screening test, treatment and successful cure of active infection could be increased, improving patient outcomes.