HCV Screening and Treatment in Community Health Centers

High HCV case rates have been reported in primary care settings such as community health centers in underserved communities. We will investigate the clinical benefits and cost-effectiveness of various models for HCV screening in community health centers. We will employ the HEP-CE model to project QUALYs, life-time costs, and incremental cost-effectiveness ratios associated with 8 screening strategies. The strategies will differ in three ways:

1. Rapid finger stick vs. venipuncture diagnostics
2. Testing initiated by a physician vs. a dedicated HCV counselor and tester using standing orders
3. Targeted testing of people who inject drugs vs. universal one-time testing

All rapid testing results will be available during the visit. The influence of reflex testing, linkage to care strategies such as patient navigation, and insurance claims assistance will also be evaluated.

The analysis will then be expanded to:

1. Assess the optimal frequency of testing among those with known injection drug use
2. Determine cost-effectiveness of screening when HCV treatment is restricted to those with greater than F2 fibrosis and with at least 12 months of abstinence from substance use
3. Develop a cost-effectiveness tool that will allow local jurisdictions around the country to enter limited number of parameters based on local data to evaluate the clinical benefit and cost-effectiveness of screening in primary care setting at community health centers.