The Efficacy and Sustainability of an Implementation Intervention (FOCUS Program) on Linkage to Hepatitis C Care Time at a Community Health Center in the Deep South: A Longitudinal Study Based on Electronic Medical Records

Abstract

People with hepatitis C should be identified and promptly linked to care after diagnosis to eliminate hepatitis C virus (HCV) infection by 2030. An implementation intervention, an HCV screening and linkage to care intervention, the FOCUS program, highlighted by four pillars (normalisation of routine testing, promotion of testing based on electronic medical records [EMR], procedure overseen by linkage coordinator, and quality improvement training/feedback among staff), has been conducted in a community health center in South Carolina from 2018 to 2020. We aim to assess the impacts of this intervention on linkage to care time and its sustainability. We analysed a cohort (n = 593) of adults who tested positive for hepatitis C infection, all of whom received hepatitis C care services from the Cooperative Health Center (January 2015 to March 2023) from the EMR data. Descriptive analysis was employed for outcome (linkage to care days [LTC days]) and sociodemographic variables (i.e., race, sex, age, health insurance). We compared the sociodemographic and average LTC days among pre-intervention (2015–2017), during-intervention (2018–2020), and post-intervention (2021–2023) phases. Multivariate linear regressions were conducted on LTC days and intervention phases, controlling for relevant covariates. Most (59.5%) of the participants were 45 to 64 years of age. Sixty percent were males, and 57% were African Americans. Around 45% of the participants did not have health insurance. The mean LTC days at pre-intervention were 66.68 (SD = 72.29). LTC days reduced by 31 days during the intervention compared to pre-intervention (ß = −31.21, p < 0.001). Similarly, in the post-intervention phase, LTC days reduced by 30 days compared to pre-intervention (ß = −29.96, p < 0.001). Age was associated with LTC days, with middle-aged people (45–64 years) having the longest LTC days. Our study suggests that the intervention had a robust immediate effect, which was maintained in the post-intervention period, thus highlighting its lasting impact. Since its implementation, the FOCUS program has significantly shortened the days of linkage to care for people with hepatitis C. We noted the positive impacts across the different demographics studied. More importantly, the impacts were sustainable through the COVID-19 pandemic. We need future efforts to engage middle-aged groups to further reduce the hepatitis C LTC days.