A Sustainable Surveillance-Based Approach to Creating a State-Level HCV Cascade of Care for HIV/HCV Co-Infected Persons

Background: The HIV cascade of care (CoC) model has been used to evaluate HIV-related health outcomes. Similar approaches have been applied to HCV mono-infected individuals; published CoC have relied on sources other than public health surveillance data. This study addresses this through a surveillance-only approach using two public health surveillance databases. Methods: We linked Connecticut’s (CT) HIV (the enhanced HIV/AIDS reporting System [eHARS]) and HCV (the CT Electronic Disease Surveillance System [CTEDSS]) surveillance databases, creating a co-infected list. We used HCV laboratory results to define the care status of each patient for appropriate CoC designation. Three CoC algorithms were assessed to measure their effects on calculated sustained virologic response (SVR) rates. Multivariate analysis was completed to measure those most likely to achieve SVR for each algorithm. Findings: HCV CoC SVR rates ranged from 37.1%-69.2%, depending on the algorithm used. Those significantly more likely to achieve SVR were baby-boomers and those with HIV viral suppression. Trends across CoC algorithms showed Black and Hispanic persons, females, and those with heterosexual HIV transmission were less likely to achieve SVR. Interpretation: We successfully developed a surveillance-based approach to creating a statewide HCV CoC for HIV/HCV co-infected individuals. Those not achieving SVR were identified, allowing future engagement strategies to focus on them. Furthermore, the methods presented can be adopted and implemented at state, local, or national level agencies. Funding: This work is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award U90HA31462. Declaration of Interest: None to declare. Ethical Approval: The Department of Public Health Human Investigations Committee approved this research project