Hepatitis C Screening Best Practices Jenitza Serrano-Feliciano M.D MHC Healthcare Hepatitis C Screening Best Practices Jenitza Serrano-Feliciano M.D

Hepatitis C Viral infection 75 - 85% of people that get in contact with the virus develop chronic infection One of the most common cause of liver disease Leading indication for liver transplant in the US

Transmission is mostly through contaminated blood and bodily fluids Transmission is mostly through contaminated blood and bodily fluids. It can also be transmitted from mother to child, sexual intercourse, sharing needles, transplant and blood transfusions before 1992. No vaccine available IT CAN BE CURED!!!!!

Screening Recommended by several agencies including CDC and USPSTF is to screen all of those patients born between 1945 – 1965. Approximately, 75% of Hepatitis C cases are baby boomers. High risk populations should also be screened.

Regardless of Any Symptoms, Screen Patients Who Have Any of These Risk Factors1-3 In addition to baby boomers, the CDC, USPSTF, and AASLD recommend screening for individuals with a high-risk of exposure to HCV. These include: Persons who have ever injected illegal drugs HIV-infected patients Those with tattoos received in unregulated environments Those with medical conditions requiring clotting factor, undergoing long-term hemodialysis, or with persistently abnormal ALT levels Patients who received transfusions or organ transplants before July 1992 or from donors who later tested positive for HCV Healthcare workers exposed to HCV-positive blood Children born to an HCV-positive mother 1. Smith BD et al. MMWR Recomm Rep. 2012;61(RR-4):1-32. 2. USPSTF. http://www.uspreventiveservicestaskforce.org/uspstf12/hepc/hepcfinalrs.htm. Accessed December 7, 2015. 3. AASLD, IDSA, IAS-USA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed December 7, 2015.

It is estimated that 3.5 million of Americans have chronic Hepatitis C.

GOAL: IMPROVE PROPER SCREENING AND ACCESS TO TREATMENT

STEP 1: EDUCATION MHC’s clinical leadership provided education to providers through different ways of communication including email and provider meetings. Partnered with Gilead who provided Lunch and Learns across all clinics on proper screening, diagnosis and treatment. Onsite Webinar with outside primary care physician with extensive experience treating Hep C.

STEP 2: REMINDERS

STEP 3: DATA COLLECTION In 2015, a total of 112 patients were screened for Hep C; 15% of them were baby boomers. 2017 screened 1554 patients, 85% of them baby boomers. 249 patients were referred to GI for Hep C treatment. 7 patients were started on treatment by MHC providers

Recent Changes and Next Steps Added Hep C screening to the Lab Standing Orders. Continue to provide treatment education and availability of resources to medical providers to improve treatment rates without the need to refer.