Leveraging The Emergency Department as a Public Health Safety Net For Hepatitis C and HIV Services

Author: Barbra Cave Kimberly Laun Suzannah Burch Ashlee Melendez Adam Ross

Theme: Models of Care Year: 2022

Primarily due to high rates of injection drug use, Kentucky is a leader in hepatitis C virus (HCV) and
human immunodeficiency virus (HIV) infections. Investigators developed a self-sustaining model of
HIV/HCV screening and diagnosis, linkage-to-care (LTC), and harm reduction (HR) services within an
academic medical center in Kentucky. Program objectives included increased rate of HCV/HIV
diagnoses, LTC, and utilization of HR strategies.
Description of model of care/intervention:
In 2019, a computer-based algorithm identified emergency department patients 18-45 years old
who had not had HCV antibody and/or viral load in the previous 90 days, had an HCV risk factor, and
did not opt-out. In 2020, the program added HIV testing. To align with Centers for Disease Control
guidance, universal screening began in June 2021. Lab ordering was automated; results, education
and LTC were completed by navigators. People living with HCV and/or HIV were linked to care and
HR; people at-risk, especially people who inject drugs(PWID) were offered HR. The cost of the
program was offset by referring patients for services within the health system.
The number of HCV and HIV diagnoses increased despite the evolving COVID-19 pandemic (Figure 1).
The program was credited for identifying an HIV cluster among local PWID. Nearly 25% of people
with HCV were LTC within 30 days of diagnosis; people living with HIV were confirmed as already
being in care or LTC in 94% of cases. PWID could link to local syringe exchange programs, receive
naloxone, and have other needs addressed by navigators.
Conclusion and next steps:
In high HCV and HIV prevalence settings, universal testing uncovers high numbers of undiagnosed or
out-of-care people, including PWID. Testing and LTC offer opportunities for education and
implementation of HR strategies. This safety net model may lead to reduced disease burden in the
community and improved health for people who use drugs.
Disclosure of Interest Statement:
The model of care described here would not have been possible without a Frontlines of Communities
in the United States (FOCUS) grant sponsored by Gilead Sciences. Gilead had no direct input into the
model development or outcomes reported here.

Download abstract Download poster