BACKGROUND

1. Point-of-care Testing for Hepatitis C Screening at Community-Based Organizations Facilitates Disease Control CT Nguyen, BS1, BN Tran, PharmD, MBA2, J Fontanesi, Ph.D3, RG Gish, MD4 1 Skaggs School of Pharmacy, University of California, San Diego, US; 2 Asian Pacific Health Foundation (APHF), San Diego, US; 3 Center for Management Science in Health, UCSD, San Diego, US; 4 Robert G Gish Consultants LLC, La Jolla, US BACKGROUND RESULTS • HCV has a prevalence of 5.2 million in the United States1, with 70 – 80% of those affected are unaware of the danger due to the asymptomatic nature of hepatitis2. • Majority of people infected with HCV develop chronic infection, which can lead to scarring of the liver and ultimately cirrhosis. • At least 75% of adults infected with HCV are baby boomers, those who were born from 1945 through 1965, when the rates of Hepatitis C infection were high3. • Currently, there is no vaccination to prevent viral infection, however, early detection prevents the progression to liver cirrhosis and cancer. • The Centers for Disease Control and Prevention (CDC) recommends HCV testing for all in the birth cohort (1945-1965). However, traditional blood drawing tests will not be feasible to screen 26.4% (81.4 million baby boomers) of the U.S. population. • A successful mass screening depends on the type of operational system—a clinic’s workflow or staffing is different from a community event’s setting, which differs in unit cost of screening. Fig. 1: Process map of HCV screening at Community-Based Organization (CBO) event and at the federally qualified health clinics. Set-up at the established site Eligibility Assessment Blood-draw Sample Testing Reactivity (results) KEY: CBO Clinic Mutual Check-in at Reception Vital signs check Examined by Provider Post-test counseling Schedule 2nd appointment with provider or offer a case manager Table 1: Sample screened monthly at various clinics & community locations in San Diego County, United States. • Patient characteristics consist of: the mean age of 53 years, 63.3% women; 48.8% Asian; 29% Hispanics. • The unit costs of CBO screening were $36.11 compared to $40.49 when performed at a clinic. • Sensitivity analysis shows the cost model as most sensitive to the costs of personnel. The highest level of health care professional to oversee a community event requires a pharmacist with a median hourly wages of $56.09 (49.69, 64.28). • A nurse practitioner or physician assistant is qualified to see individual patient at the clinic. Their median hourly wages are: $43.75 (37.70, 51.21) and $43.72 ( 37.81, 52.20), respectively. OBJECTIVES • HCV point-of-care (POC) testing at Community-Based Organizations (CBO) is cost-effective in facilitating disease control as compared to testing in clinic setting. METHODS CONCLUSIONS • This research is a field study using convenient sampling from which HCV screening were performed at different community events. • 629 Individuals were recruited and screened for HCV at health fairs and outreach events organized by the Asian Pacific Health Foundation in San Diego and UC San Diego AntiViral Research Center (AVRC). • After informed consent was obtained, blood samples from venipuncture were screened for anti-HCV using the OraQuick HCV Rapid Antibody test. Individuals received onsite consultations from health providers; in subsequent linkage to care, patients with positive results were referred to specialists for further treatments: on site for POC and via a call back for standard of care tests. • Tasks were specifically assigned to different personnel with pertinent licensure or capability. Data collection. • The time required to perform each activity throughout the process of a single screening was recorded. • Data were entered in the REDcap (Research Electronic Data Capture) program, and the workflow during the operation was also recorded. • The staffing hourly wages were retrieved from the United States Bureau of Labor Statistics (USBLS) were used to calculate the unit cost of 1 testing. Data Analysis/Statistical Analysis. • Non-parametric analysis was used to calculate unit cost of testing completed at CBO and the clinics. • Screening at CBO is more cost-effective and convenient for larger at-risk HCV populations as compared to the operation at clinics. • This finding can be further evaluated by Markov modeling to derive the probability of disease state development and risk reduction in early treatment versus the probability in late detection or delays in linkage to care when standard of care tests are used. This estimates the future benefit of early screening. • By providing early detection and treatments to suppress the viral load, the proportion of disease risks due to chronic infection will decline. The general population also benefits from immediate onsite counseling REFERENCES ACKNOWLEDGEMENTS • Chak E, Talal AH, Sherman KE, Schiff ER, Saab, S. Hepatitis C virus infection in US: an estimate of true prevalence. Liver International. John Wiley & Sons A/S. 2011. • Centers for Disease Control and Prevention. Hepatitis C FAQs for the Public. 2012. http://www.cdc.gov/hepatitis/C/cFAQ.htm#statistics • Centers for Disease Control and Prevention. Hepatits C information for health professionals: statistics and surveillance. 2011. Howden LM, Meyer JA. Age and Sex Composition: 2010. U.S. Census Bureau. 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf • http://www.bls.gov/bls/exit_BLS.htm?url=http://www.dol.gov This study was generously supported by Skaggs School of Pharmacy and Pharmaceutical Sciences through a summer research stipend. The authors acknowledge the work by members of the Asian Pacific Health Foundation and pre- and current pharmacy student volunteers from UCSD.