New York State Hepatitis C Testing Law Increases Screening and Linkage to Care

Hepatitis C (HCV) testing rates increased significantly after the enactment of the New York State (NYS) Hepatitis C Testing Law on Jan. 1, 2014, and linkage-to-care rates also increased, according to a study presented at Liver Meeting 2016 in Boston.

The NYS Hepatitis C Testing Law, the first state-level HCV testing law in the nation, requires care providers to offer an HCV test to all individuals born between 1945 and 1965 (baby boomers). If the test is accepted and comes back positive, the law requires providing follow-up health care or a referral to a provider who can provide follow-up health care.

The study, which was presented by Colleen Flanigan, RN, M.S., director of the New York State Department of Health (NYSDOH) AIDS Institute, looked at multiple components to evaluate the impact of the HCV testing law on screening and linkage to care.

The components evaluated included:

• Survey of laboratories (i.e., commercial, public health and hospital-based).

• Analysis of Behavioral Risk Factor Surveillance System survey results.

• Analysis of NYS Medicaid data.

• Analysis of New York City Department of Health and Mental Hygiene. (NYCDOHMH) Primary Care Information Project (PCIP) data.

• Analysis of NYS and NYC surveillance data.

Laboratory Survey Results

Surveys from 106 centers that provide HCV testing were included in the analysis. Overall, the number of HCV tests increased 51% between 2013 and 2014, after the law was passed. Of the 106 laboratories, 78 providing NYS-specific data showed a screening increase of 65.9%. At the 28 laboratories that could not report NYS-specific data, the increase was 31.6%.

"There had been a gradual increase of about 400 HCV tests per month in 2013 before the law was enacted. After the enactment of the law, about 1,090 HCV tests were added each month in 2014," Flanigan stated during the study presentation.

Behavioral Risk Factor Surveillance System Survey Results

The Behavioral Risk Factor Surveillance System Survey (BRFSS) is an annual CDC (U.S. Centers for Disease Control and Prevention) state-based telephone survey administered by the NYSDOH. Based on this survey, the percentage of NYS baby boomers tested for HCV increased from 25.4% in 2013 to 32.1% in 2014 -- meaning that an estimated 270,000 additional baby boomers were tested for HCV.

About 17.1% of those who received inpatient care at a hospital said they were offered an HCV test, compared with 10.7% of those who received care from a primary physician.

Overall, of those who were offered an HCV test, 71.2% said they accepted.

New York City Primary Care Information Project

The New York City Department of Health and Mental Hygiene's (NYC DOHMH) Primary Care Information Project (PCIP) is a program that supports the adoption and use of electronic health records (EHRs) by care providers assisting New York City's underserved communities. The researchers looked at EHR data from 24 community health centers, four hospital outpatient clinics and 345 independent practices. They specifically looked at the number of baby boomers who had a documented HCV test in 2013 and then in 2014.

In total, about 4.8% of baby boomers tested in 2013; that number increased to about 6.7% in 2014 -- a 37% increase in the proportion of patients tested, but a 46% increase in the number of patients tested (an additional 22,487 baby boomers tested in New York City).

NYS Medicaid Data on HCV Testing Rates

The researchers also analyzed de-identified billing data from NYS Medicaid over a three-year period between 2012 and 2014 -- or two years before and one year after the testing law enactment. Only "active utilizers," meaning Medicaid patients between the ages of 50 and 70 who received paid services in any given month, were included in the analysis.

Looking at the HCV testing rate per 1,000 NYS Medicaid active utilizers, the researchers found a clear increase in testing after the law's enactment, from 7.68 per 1,000 in Dec. 2013 to 10.66 per 1,000 in Jan. 2014.

The HCV testing rate per 1,000 among this population peaked at 14.15 per 1,000 in April 2014, nearly doubling the lowest rate seen within the three-year period of 7.32 per 1,000 in Dec. 2012.

After excluding baby boomers, this huge increase was not observed among the general population within the same time period, leading the researchers to conclude that the testing increase was attributable to the testing law.

NYS Medicaid Data on Linkage to Care

Looking at NYS Medicaid billing data, the researchers again identified active utilizers of Medicaid between the ages of 50 and 70 who received an HCV test between 2012 and 2014. Of those who received an HCV test, those who also received HCV RNA testing in the same year were considered to be linked to HCV care.

The total number linked to care was 13,898 in 2012 and 13,839 in 2013, about the same both years before the enactment of the testing law. In 2014, after the testing law was passed, the total number linked to care increased to 18,614 -- a linkage-to-care increase of 35%.

Surveillance Data on Linkage to Care

HCV surveillance data from the New York State Department of Health and the NYC DOHMH were used to identify the proportion of newly diagnosed HCV-positive patients who were linked to care. In this analysis, linkage to care was defined as either two or more positive HCV RNA tests or one positive HCV RNA test and a genotype test within six months of diagnosis.

In NYS excluding NYC, between 2011 and 2013 about 24.1% of newly diagnosed patients were linked to care. Then, in 2014 after enactment of the testing law, that proportion increased to 33.7% -- a linkage-to-care increase of 39.8%.

In NYC, between 2011 and 2013 about 19.5% of newly diagnosed patients were linked to care. Then, in 2014, that proportion increased to 21.7% -- a linkage-to-care increase of 11.2% after the testing law passed.

One limitation was that that negative HCV RNA test results were not reportable during most of the evaluation period; therefore, in reality more people could have been linked to care, according to the researchers.

Conclusion

Based on evaluating these different components, a significant increase in HCV testing and linkage to care occurred in the first year among baby boomers after the NYS HCV testing law was enacted, the researchers concluded.