Author: Capraru CI, Hansen BE, Vanderhoff AM, Friedman SM, Bates K, Mazzulli T, Porplycia D, McCormack B, Juan J, Jung HM, Shah H, Feld JJ, Janssen HLA

Theme: Epidemiology & Public Health Research Year: 2019

Background: It is estimated that over 45% of individuals with chronic hepatitis C virus (HCV)
infection in Canada remain undiagnosed. Understanding current rates of HCV diagnosis and linkage
to care in different community settings is critical information for developing future screening
Our aim is to evaluate HCV screening strategies in three different community settings: emergency
department (ED), medical walk-in clinic (MC) and community outreach drives (CO).
Methods: We implemented birth cohort (1945-1975) HCV testing in the ED and MC, and universal
testing during CO. Community outreach includes shelters, drop-ins, health fairs and addiction clinics.
Blood samples in the ED were collected by finger prick on Dried Blood Spot (DBS) collection cards and
tested for anti-HCV with reflex to HCV RNA. In the MC and CO, we used anti-HCV point-of-care testing
followed by HCV RNA on DBS card. Patients with positive HCV RNA were linked to care.
Results: 6,118 individuals were tested during 1.5 years; 196 (3.2%) were HCV reactive. Seropositivity
varied among all three groups: 1.8% (95%CI 1.3%-2.5%) in the ED, 0.4% (95%CI 0.1%-0.9%) in the MC
and 5.6% (95%CI 4.8%-6.5%) in the CO. Of Ab positives, 167 (85.2%) underwent HCV RNA testing.
105 (92.1%) out of 114 HCV RNA positives were linked to care. Compared to the general population
the HCV prevalence was significantly higher in the CO (5.6% vs. 0.7%; p < 0.0001), and in the ED (1.8% vs. 0.7%; p < 0.0001). The MC group exhibited similar seropositivity as the general population (0.4% vs. 0.7%; p = 0.11). Conclusion: The HCV prevalence in the CO and ED was significantly higher than the general Canadian population. Using DBS for HCV testing ensured high HCV RNA test uptake. Screening efforts in populations with higher prevalence, such as the ED and outreach programs, resulted in higher yield and good linkage to care. Disclosure of Interest Statement: Made possible through the support of Gilead Sciences Inc., AbbVie, Merck Canada Inc. and OraSure Technologies Inc./KNS Canada Inc. The funding sources did not have any influence on study design, data collection, analysis and interpretation of the data, writing of the report nor the decision to submit for publication.

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