Hepatitis C virus (HCV) is a public health problem and is a leading indicator of liver transplantation. HCV is efficiently transmitted through exposure to contaminated blood products and equipment, such as unsterile needles and injecting equipment.
Therefore, a large proportion of HIV-infected individuals in co-infected with HCV. Washington DC has one of the highest HIV/AIDS case rates in the country, and also has a high burden of HCV infection with more than 13,000 cases reported between 2006-10. The CDC recently recommended that all individuals born in 1945-1965 be screened for HCV at least once in their lifetime. Is it unclear how these recommendations will be implemented in jurisdictions with a very high prevalence of HCV, and whether the capacity for treatment is in place for these newly identified cases.
Engaging newly-diagnosed individuals as well as individuals with known HCV infection may be a challenge, and linkage patterns from diagnosis to evaluation to treatment are poorly understood. The main aims of this pilot study are to demonstrate the feasibility of community-based rapid HCV testing and determine the HCV seroprevalence among community-recruited individuals at elevated risk for HIV born in 1945-1965 in Washington DC; and to determine the proportion that links to HCV care using an enhanced linkage to care and mHealth protocol compared to a standard referral. We will collaborate with Community Education Group (CEG) to recruit and test 200 individuals born in 1945- 1965 from Washington, DC (primarily Wards 7 and 8) through street recruitment, word of mouth and social network referral.
Of those testing HCV positive, half will be randomized to a standard referral to a HCV provider for medical evaluation and follow-up, and the other half randomized to the CEG's linkage protocol and Health Information Virtual Exchange (HIVE) system, which is a proactive linkage and text messaging reminder system using a cloud-based health information exchange system. The goal of this study is to demonstrate the feasibility of community-based rapid HCV testing among individuals in this targeted birth cohort who are also at risk or may be infected with HIV and conduct preliminary testing of the HIVE system compared to standard referral to HCV care.