Measuring Baseline Hepatitis C and HIV Screening Efficacy, Tattoo Prevalence, and Interest in Tattoo-Removal Services Among Patients in an MGH Community Health Center

Abstract

Purpose: The Crimson Care Collaborative (CCC) clinic at Massachusetts General Hospital’s Chelsea HealthCare Center (CHC) provides primary care for post-incarcerated and other high-risk populations for whom screening for hepatitis C (HCV) and human immunodeficiency virus (HIV) is indicated. Successful treatment of these diseases depends upon timely diagnosis and the clinic’s efficacy in screening. Tattoos are a visible risk factor for both diseases and can be a source of stigma for individuals in the community and workplace. This study seeks (1) to assess the baseline efficacy of HCV and HIV screening practices at the CCC, (2) to determine the prevalence of HCV and HIV among CHC patients, and (3) to determine the prevalence of tattoos and interest in tattoo removal services among CHC patients. Methods: A written questionnaire was used to identify patients indicated for HCV and HIV screening and to determine the prevalence of tattoos and interest in tattoo-removal services. Chart review provided participants’ screening test dates and results in order to calculate screening efficacy and the prevalence of HCV and HIV. Results: 126 patients were included in the study. Of the 35 patients indicated for HCV screening, 31 underwent screening (HCV screening efficacy of 88.6%). Of the 122 patients indicated for HIV screening, 116 underwent screening (HIV screening efficacy of 95.1%). The prevalence of HCV was 4.8% among all patients screened and 9.7% among patients indicated for screening who were screened, highest among post-incarcerated and tattooed patients. The prevalence of HIV was 0% among all patients screened. 24% of participants had at least one tattoo, and 53% of tattooed participants were interested in utilizing tattoo-removal services. Conclusions: The CCC student-faculty clinic demonstrated rates for HCV and HIV screening higher than those published by other primary care practices, but patients at risk for infection were still identified who remained unscreened. This practice gap was larger for HCV screening than HIV screening based on screening efficacy values. Risk-based HCV screening, in particular, is an area for improvement compared to birth-cohort HCV screening. The prevalence of HCV is approximately 3 times higher among CHC patients than the general U.S. population, with a history of incarceration and tattoos being the most common non-age risk factors for infection. However, a larger study is needed to more accurately study HIV prevalence at the CHC. Tattoo prevalence at the CHC is consistent with the national average, but study participants demonstrated an increased interest in utilizing tattoo removal services.