CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

532 Influence of Hepatitis C Virus Screening on Emergency Department Length of Stay Douglas A.White 1 ; Erik S. Anderson 2 ; Sarah K. Pfeil 1 ;TamaraTodorovich 1 ; Laura J. Deering 1 ;Tarak K.Trivedi 1 1 Highland Hosp, Alameda Hlth System, Oakland, CA, USA; 2 Stanford Univ, Stanford, CA, USA

Background: In April 2014, we integrated triage nurse hepatitis C virus (HCV) screening into emergency department (ED) clinical operations. We utilized a laboratory-based testing protocol and native staffing to offer, perform, and disclose results. Because of concerns that HCV screening would increase ED length of stay (LOS), our protocol did not require patients to wait for their HCV test results prior to discharge. The objective of this study was to assess the impact of this integrated HCV screening protocol on ED LOS. Methods: In this retrospective cohort study we analyzed prospectively collected timestamp data for all discharged patients. The primary outcome compared the median LOS in minutes between patients who completed HCV screening and those who did not. We additionally stratified patients based on whether or not other laboratory testing was done, using complete blood count (CBC) tests as a surrogate. Length of stay was defined as the time between triage (timestamped when intake begins) and discharge (timestamped when discharge instructions are printed). Results: Over the 1-year study period, LOS was calculated for 69,639 (96%) of the 72,338 visits for which patients were discharged. The LOS for visits that included HCV screening (n = 2,864) was 151 minutes (IQR 66 to 251) compared with 119 minutes (IQR 48 to 221) for visits that did not include HCV screening (n = 66,775) (p < 0.001). Among the 49,726 visits in which no CBC testing was performed, there was a significant difference in LOS between the 1,701 visits that included HCV screening (86 minutes, IQR 38 to 158) and the 48,025 visits did not (77 minutes, IQR 34 to 150) (p < 0.001). However, among the 19,913 visits in which CBC testing was performed, there was no significant difference in LOS between the 1,163 visits that also included HCV screening (240 minutes, IQR 173 to 339) and the 18,750 visits that did not (242 minutes, IQR 170 to 347) (p = 0.68). Conclusions: We show that an integrated HCV screening programmodestly prolongs overall ED LOS. However, among patients undergoing other blood tests, HCV screening had no significant effect on LOS. Emergency departments must consider whether the public health benefit of screening justifies the impact on quality metrics, such as LOS, which has been shown to influence the ability to provide timely acute care. Future programs may consider routinely offering HCV screening to patients who are undergoing laboratory testing. 533 Devising a Strategy to Control the HCV Epidemic in British Columbia, Canada Background: In 2012, less than 1% of the estimated 12,000 hepatitis C (HCV) infected people who inject drugs (PWID) in British Columbia (BC) received HCV treatment, despite accounting for 80% of all new HCV infections. The recent approval and availability of high-efficacy and tolerable HCV medications will make it possible to treat a large number of individuals who were previously ineligible for treatment. Reinfection risk remains an issue, particularly among PWID, and it is still not clear if individuals who achieve sustained virologic response gain some degree of subsequent immunity. Reinfection risk could also be mitigated by engaging individuals in harm reduction programs. Methods: We designed a deterministic compartmental mathematical model of HCV disease transmission fit to the PWID population in BC, based on treating a fixed number of individuals per year. We calculated the difference in incident cases with respect to the status-quo, as a function of both the number of PWID treated per year, and varying rates of reinfection risk. We defined the threshold for HCV control as the minimum number of PWID treated per year required to offset the number of new incident cases, with removals taken into account. Results: The control threshold at year five (Figure 1A) ranged from 128 PWID treated per year, assuming 0% reinfection risk, to 178 when there is 100% reinfection risk, i.e., equal to naïve uninfected PWID. At ten years (Figure 1B), the threshold varied between 121 and 240 individuals treated. We simulated the change in incident cases (Figures 1C-1D) when treating 100 or 300 PWID per year, for varying rates of reinfection risk reduction. In the first scenario (100 treated per year, Figure 1C), after 20 years of constant treatment uptake, the number of incident cases was reduced between 1% and 16%. In the second scenario (300 treated per year, Figure 1D), the number of incident cases decreased between 16% and 54%. Conclusions: The availability of highly efficacious treatments holds great promise to disrupt the course of the HCV epidemic. Treating the PWID population is crucial to controlling the epidemic, as the majority of new infections occur within this population, but reinfection risk remains a concern. Our simulations show that treating a minimum of 200 to 300 PWID per year will lead to HCV control, and this will be substantially accelerated if the potential for HCV reinfection is minimized through the deployment of harm reduction programs. Ignacio Rozada ; Julio Montaner; MarkW. Hull;Viviane D. Lima British Columbia Cntr for Excellence in HIV/AIDS, Vancouver, BC, Canada

Poster Abstracts

208

CROI 2016