In-Hospital Hepatitis C Alarm System: A Strategy to Enhance Linkage to Care for Hepatitis C Virus Infection

The World Health Organization aims to eliminate hepatitis C virus (HCV) by 2030; however, linkage to care rates remain suboptimal. To address this, an in-hospital HCV alarm system integrated into electronic medical records (EMRs) was implemented to increase confirmatory testing and referral rates. This retrospective study analyzed patients with positive anti-HCV antibody results at a tertiary hospital in Korea, comparing the pre-alarm period (August 2020-July 2022) with the post-alarm period (July 2022-May 2024). HCV RNA testing rates, liver clinic visits, and direct-acting antiviral (DAA) prescriptions were assessed. Multivariate logistic regression was performed to identify factors associated with the lack of HCV RNA testing implementation. Among 941 patients who tested positive for anti-HCV antibodies, the proportion of patients who underwent HCV RNA testing significantly increased from 49.4% in the pre-alarm period to 67.8% in the post-alarm period (p<0.001). The rate of referral to liver specialists also showed an increasing trend (89.4% vs 93.2%), while DAA initiation rates remained similar (68.4% vs 72.0%). Multivariate analysis revealed that older age, surgical or emergency department admission, and non-liver-related testing indications were independent predictors of the lack of HCV RNA testing implementation. Implementation of an in-hospital HCV alarm system significantly increased HCV RNA testing rates, enhancing early diagnosis and linkage to care. While referral rates remained high, persistently low testing rates in emergency departments highlight the need for targeted interventions. A cost-effective, EMR-integrated alarm system may be a feasible strategy to support national HCV elimination efforts.