Enhancing Hepatitis C Virus Testing, Linkage to Care, and Treatment Commencement in Hospitals: A Systematic Review and Meta-analysis.

Abstract

Background: The hospital-led interventions yielding the best hepatitis C virus (HCV) testing and treatment uptake are poorly understood.

Methods: We searched Medline, Embase, and Cochrane databases for studies assessing outcomes of hospital-led interventions for HCV antibody or RNA testing uptake, linkage to care, or direct-acting antiviral commencement compared with usual care, a historical comparator, or control group. We systematically reviewed hospital-led interventions delivered in inpatient units, outpatient clinics, or emergency departments. Random-effects meta-analysis estimated pooled odds ratios [pORs] measuring associations between interventions and outcomes. Subgroup analyses explored outcomes by intervention type.

Results: A total of 7872 abstracts were screened with 23 studies included. Twelve studies (222 868 participants) reported antibody testing uptake, 5 (n = 4987) reported RNA testing uptake, 7 (n = 3185) reported linkage to care, and 4 (n = 1344) reported treatment commencement. Hospital-led interventions were associated with increased antibody testing uptake (pOR, 5.83 [95% confidence interval {CI}, 2.49-13.61]; I ² = 99.9%), RNA testing uptake (pOR, 10.65 [95% CI, 1.70-66.50]; I ² = 97.9%), and linkage to care (pOR, 1.75 [95% CI, 1.10-2.79]; I ² = 79.9%) when data were pooled and assessed against comparators. Automated opt-out testing (5 studies: pOR, 16.13 [95% CI, 3.35-77.66]), reflex RNA testing (4 studies: pOR, 25.04 [95% CI, 3.63-172.7]), and care coordination and financial incentives (4 studies: pOR, 2.73 [95% CI, 1.85-4.03]) showed the greatest increases in antibody and RNA testing uptake and linkage to care, respectively. No intervention increased uptake at all care cascade steps.

Conclusions: Automated antibody and reflex RNA testing increase HCV testing uptake in hospitals but have limited impact on linkage to treatment. Other interventions promoting linkage must be explored.