(P141) Sentinel surveillance to assess HIV/HCV coinfection prevalence across Southern Texas

Background

The epicenter of the HIV epidemic in the United States is the South. 25-33% of adults with HIV are co-infected with hepatitis C virus (HCV). Data on chronic HCV infection among people with HIV (PWH) in Texas is limited, chronic HCV is not reportable. Through the Targeted Access to Community Knowledge, Linkage to treatment and Education for HIV/HCV in people of color (TACKLE HIV/HCV) program, data regarding HIV/HCV coinfection in South Texas was collected and analyzed with an emphasis on the HCV care cascade.

Methods

A sentinel surveillance system was established as part of TACKLE HIV/HCV in collaboration with the state health department and targeted five clinical sites across the Southern Texas region. HIV/HCV coinfection surveillance protocols were established for identifying and reporting HIV/HCV coinfection which enabled consistent data collection across the clinical sites. The number of PWH screened for HCV was tracked prospectively from October 2018 through September 2021. Descriptive data detail the prevalence of HIV/HCV coinfection and mark timepoints in patients’ HCV care: prescribing, starting, completing HCV treatment, and achieving sustained virologic response after 12-week post-treatment (SVR12). Descriptive data also identify reasons of patients lost to follow-up.

Results

During the study timeframe, 2,282 PWH were screened for HCV and 305 had confirmed chronic infection giving a prevalence of 13%. HIV/HCV coinfected patients had a mean age of 47 years, were predominately male (74%), Hispanic (63%), and uninsured (54%). Figure 1 details the HCV care continuum. Reasons for lost to follow-up include the following: unknown (56%), incarceration (23%), moving (15%), substance use (4%), pregnancy 1% and death 1%.

Conclusion

This study contributes to comprehensive understanding of the prevalence of HIV/HCV coinfection in South Texas. Even with availability of highly effective curative treatment with Direct-Acting Antivirals (DAAs), treatment initiation was low due to a high proportion of lost to follow-up (27%). DAA availability alone is insufficient to eliminate HCV in PWH. Specific strategies to reengage patients lost to follow up are needed, such as having a retention specialist, leveraging peer support and community health workers and facilitating access for those incarcerated at the jail level (unpredictable duration) versus prison level (clearer duration).