CROI 2015 Program and Abstracts

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Poster Abstracts

receiving care; 70%were newly identified, of whom 51% had never been HCV tested before. HCV-seropositive individuals were older than negative individuals and were more likely to have ever injected drugs and have a history of incarceration (Table).

Conclusions: Conducting community testing using this algorithm yielded a high HCV seroprevalence and large number of newly identified/out of care seropositive baby boomers. A high proportion had never been HCV tested, suggesting this testing paradigmmay be effective in reaching individuals potentially at high risk for HCV in a community-based setting. 666 Low HCV Screening Uptake of the Current Birth Cohort Testing Guidelines Alexander G. Geboy 1 ; Hyun A. Cha 1 ; Idene E. Perez 1 ; MatthewT. Bell 1 ; Sandeep Mahajan 2 ; Adebisi O. Ayodele 2 ; Dawn A. Fishbein 2 1 MedStar Health Research Institute, Hyattsville, MD, US; 2 MedStar Washington Hospital Center, Washington, DC, US Background: The CMS recently supported the CDC and USPSTF grade B recommendation, and now covers a single HCV screening test if ordered by a primary care provider (PCP) to screen all persons born 1945-1965 (Birth Cohort) given a 3.25% prevalence rate. Previously published HCV rates of 2.5% in all persons in Washington, DC, and other urban areas, will likely increase with expanded testing. Methods: In December 2012, we established a HCV testing program in the Primary Care Clinic at MedStar Washington Hospital Center, with CDC grant funding, to enhance testing for HCV infections among the Birth Cohort and not previously aware of their infection, link to care, and provide counseling, treatment and preventative services. Eligibility includes: born 1945-1965, without predetermined risk factors listed in the medical record, and not previously HCV tested or positive. HCV antibody positive (Ab+) patients are linked to care with Infectious Disease or Gastroenterology regardless of RNA status. Results reflect enrollment data from both the original grant and additional an CDC grant for expanded testing. Results: As of September 23, 2014, 7.8% of the 1875 tested were HCV Ab+, 54% HCV RNA+, and this was no different from the first grant. Mean age of HCV Ab+ was 59.9 + 5.6 years; 53.1%were men, and 76% had public insurance (Medicare or Medicaid); 85% of those tested, and 93% of those HCV Ab+ were black (13% b/AA men, 6% b/AA women). Those HCV Ab+ were more likely to be men (OR 1.9 [CI 95 1.1-3.4]) and have public insurance (OR 2.8 [CI 95 1.9-4.1]) than HCV Ab -. Unique primary care clinic appointments for those eligible (1 st documented visit identified in the EMR) were 4016: 1248(31%) were tested, 974(24%) were missed (not tested but completed appointment), and 1794(45%) either canceled or no-showed. Conclusions: The HCV Ab+ prevalence rate of 7.8% remained consistent over the two years and is significantly higher than the CDC Birth Cohort rate of 3.25% and the Washignton, DC rate of 2.5%, although the latter reports all ages. Overall screening uptake, however, remains low at 24%. Given these high prevalence rates, new CMS recommendations, and improved therapeutic options available, testing initiatives in Primary Care settings need to be more rigorously upheld, and internal champions are needed 1 Johns Hopkins University School of Medicine, Baltimore, MD, US; 2 National Institute of Allergy and Infectious Diseases, Baltimore, MD, US; 3 Johns Hopkins University School of Medicine, Baltimore, MD, US Background: In 2012, with a national HCV prevalence of 3.25% among “baby boomers” (born 1945-65), CDC recommended one-time HCV testing without regard to risk in this cohort, in addition to targeted testing for all with risk factors or clinical indications. Emergency departments (EDs) are a key venue for HCV testing because of their success in HIV screening given the populations they serve. However, few EDs have evaluated the underlining burden of known and unknown HCV infections in their populations before implementing an HCV testing program. Since the Hopkins ED has conducted serosurveys on HCV and HIV for the past two decades, we sought to determine the overall burden of undocumented HCV infection in our inner-city ED in order to provide guidance for an ED-based HCV testing program. Methods: An 8-week seroprevalence study with identity-unlinked methodology was conducted in an urban adult ED in 2013. All patients with blood specimens as part of their clinical procedures were included. Demographic and clinical information including documented HCV infection was obtained from administrative datasets or from electronic medical records. Anti-HCV antibody testing was performed on excess blood samples by HCV EIA after de-identification. Results: Of 4,687 patients, 650 (14%) were anti-HCV antibody positive. Of these, 203 (31%) patients did not have documented HCV infection. “Baby boomer” patients v. others had a higher overall and undocumented HCV prevalence (overall: 24.9% vs. 7.1%; unknown: 7.2% vs. 2.6%, p<0.05). Prevalence of undocumented HCV infection varied by age, gender, and race (Figure 1). Notably, the undocumented prevalence for non-Black male born after 1965 and Black men and women born between 1966 and 1977 was equal to or greater than national prevalence of 3.25% in the “baby boomer” birth cohort. Among patients with undocumented infections, 37% occurred outside the “baby boomers” cohort. Injection drug use (IDU) was reported in only 30% of patients with undocumented HCV born after 1965. If our ED adhered to the CDC guidelines, 55 (27%) patients with undocumented HCV would not be screened. to advocate for increased screening to ensure linkage to care and engagement within the HCV care cascade. 667 Evaluation of CDC Recommendations for HCV Testing in an Urban Emergency Department Yu-Hsiang Hsieh 3 ; Richard Rothman 3 ; Oliver B. Laeyendecker 2 ; Gabor Kelen 3 ; Ama Avornu 3 ; Eshan U. Patel 2 ; Jim Kim 3 ; Risha Irvin 3 ; David L.Thomas 3 ;Thomas C. Quinn 2

Poster Abstracts

416

CROI 2015