Transcript Fig. 1: Process map of HCV screening at Community

Point-of-care Testing for Hepatitis C Screening at
Community-Based Organizations Facilitates
Disease Control
CT Nguyen, BS1, BN Tran, PharmD, MBA2, J Fontanesi, Ph.D3, RG Gish, MD4
1 Skaggs School of Pharmacy, University of California, San Diego, US; 2 Asian Pacific Health Foundation (APHF), San Diego, US;
3 Center for Management Science in Health, UCSD, San Diego, US; 4 Robert G Gish Consultants LLC, La Jolla, US
BACKGROUND
• HCV has a prevalence of 5.2 million in the United
States1, with 70 – 80% of those affected are
unaware of the danger due to the asymptomatic
nature of hepatitis2.
• Majority of people infected with HCV develop
chronic infection, which can lead to scarring of the
liver and ultimately cirrhosis.
• At least 75% of adults infected with HCV are baby
boomers, those who were born from 1945
through 1965, when the rates of Hepatitis C
infection were high3.
• Currently, there is no vaccination to prevent viral
infection, however, early detection prevents the
progression to liver cirrhosis and cancer.
• The Centers for Disease Control and Prevention
(CDC) recommends HCV testing for all in the
birth cohort (1945-1965). However, traditional
blood drawing tests will not be feasible to screen
26.4% (81.4 million baby boomers) of the U.S.
population.
RESULTS
Fig. 1: Process map of HCV screening at Community-Based Organization (CBO) event
and at the federally qualified health clinics.
Set-up at the
established site
Check-in
at
Receptio
n
METHODS
• This research is a field study using convenient
sampling from which HCV screening were
performed at different community events.
• 629 Individuals were recruited and screened for
HCV at health fairs and outreach events
organized by the Asian Pacific Health Foundation
in San Diego and UC San Diego AntiViral
Research Center (AVRC).
• After informed consent was obtained, blood
samples from venipuncture were screened for
anti-HCV using the OraQuick HCV Rapid
Antibody test.
Individuals received onsite
consultations
from
health
providers;
in
subsequent linkage to care, patients with positive
results were referred to specialists for further
treatments: on site for POC and via a call back for
standard of care tests.
• Tasks were specifically assigned to different
personnel with pertinent licensure or capability.
Data collection.
• The time required to perform each activity
throughout the process of a single screening
was recorded.
• Data were entered in the REDcap (Research
Electronic Data Capture) program, and the
workflow during the operation was also recorded.
• The staffing hourly wages were retrieved from the
United States Bureau of Labor Statistics (USBLS)
were used to calculate the unit cost of 1 testing.
Data Analysis/Statistical Analysis.
• Non-parametric analysis was used to calculate
unit cost of testing completed at CBO and the
clinics.
Sample
Testing
Vital
signs
check
CBO
Clinic
Mutual
Examin
ed by
Provid
er
Table 1: Sample screened monthly at
various clinics & community locations in
San Diego County, United States.
100
90
OM
VG
ON
EC
OH
CO
VT
80
70
# Screened per Month
• HCV point-of-care (POC) testing at CommunityBased Organizations (CBO) is cost-effective in
facilitating disease control as compared to testing
in clinic setting.
Blooddraw
Reactivity
(results)
KEY:
• A successful mass screening depends on the
type of operational system—a clinic’s workflow or
staffing is different from a community event’s
setting, which differs in unit cost of screening.
OBJECTIVES
Eligibility
Assessment
Post-test
counseling
Schedule 2nd
appointment with
provider or offer a case
manager
• Patient characteristics consist of: the mean
age of 53 years, 63.3% women; 48.8% Asian;
29% Hispanics.
• The unit costs of CBO screening were $36.11
compared to $40.49 when performed at a
clinic.
• Sensitivity analysis shows the cost model as
most sensitive to the costs of personnel. The
highest level of health care professional to
oversee a community event requires a
pharmacist with a median hourly wages of
$56.09 (49.69, 64.28).
• A nurse practitioner or physician assistant is
qualified to see individual patient at the clinic.
Their median hourly wages are: $43.75 (37.70,
51.21) and $43.72 ( 37.81, 52.20),
respectively.
60
50
40
CONCLUSIONS
30
• Screening at CBO is more cost-effective and
convenient for larger at-risk HCV populations
as compared to the operation at clinics.
20
10
0
NOTE: The Federal-funded clinics were opened for
screening 20 days/month, whereas the Communitybased organization held a total of 3 one-day events in
January and 1 in March, 2013.
OM = Operation Samahan, Mira Mesa; VG = Vista Community Clinic,
Grapevine; ON = Operation Samahan, National City; VT = Vista
Community Clinic, Vale Terrance; EC = Euclid Medical & Mental
Health Services;
OH = one time testing events (clinic or community
events); CO = Community-Based events
REFERENCES
1. Chak E, Talal AH, Sherman KE, Schiff ER, Saab, S.
Hepatitis C virus infection in US: an estimate of true
prevalence. Liver International. John Wiley & Sons A/S.
2011.
2. Centers for Disease Control and Prevention. Hepatitis C
FAQs
for
the
Public.
2012.
http://www.cdc.gov/hepatitis/C/cFAQ.htm#statistics
3. Centers for Disease Control and Prevention. Hepatits C
information for health professionals: statistics and
surveillance. 2011. Howden LM, Meyer JA. Age and Sex
Composition: 2010. U.S. Census Bureau. 2011.
http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf
4. http://www.bls.gov/bls/exit_BLS.htm?url=http://www.dol.gov
• This finding can be further evaluated by
Markov modeling to derive the probability of
disease state development and risk reduction
in early treatment versus the probability in late
detection or delays in linkage to care when
standard of care tests are used.
This
estimates the future benefit of early screening.
• By providing early detection and treatments to
suppress the viral load, the proportion of
disease risks due to chronic infection will
decline. The general population also benefits
from immediate onsite counseling
ACKNOWLEDGEMENTS
This study was generously supported by Skaggs
School of Pharmacy and Pharmaceutical
Sciences through a summer research stipend. The
authors acknowledge the work by members of the
Asian Pacific Health Foundation and pre- and
current pharmacy student volunteers from UCSD.