The Determining Effective Testing in Emergency Departments and Care Coordination on Treatment Outcomes (DETECT) for Hepatitis C (Hep C) Linkage-to-Care Trial: rationale and design of an emergency department-based randomized clinical trial of linkage-to-care strategies for hepatitis C
Authors: Rowan Sarah E. , Haukoos Jason , Kamis Kevin F. , Hopkins Emily , Gravitz Stephanie , Lyle Carolynn , Al-Tayyib Alia A. , Gardner Edward M. , Galbraith James W. , Hsieh Yu-Hsiang , Lyons Michael S. , Rothman Richard E. , White Douglas A. E. , Morgan Jake R. , Linas Benjamin P. , Sabel Allison L. , Wyles David L. ,   for The DETECT Hep C Trials Investigators, Adler Amy , Alishahi Musheng , Avornu Gideon D. , Becerra Alexis , Becerra-Ashby Erika , Bellamy Meghan , Bot Samantha , Boyle Alexander J. , Bracey Annetta M. , Breyer Michael , Camacho Claudia , Cupelo Alicia , Dashler Gaby , Doyle Pamela , Eicher Amy , Gardner Heather , de Gruiter Carrie Anne , Henry Sophia , Higgins David , Hill Trevor , Houk Rachel , Johnson Nyah , Kile Alex , Liebl Janet , Maliszewski Barbara , Maliszewski Kendall , McGoey Robert , McKenzie Catherine , Minturn Matthew S. , Myer Deanna , Neumann Kendra , Ossian Cole , Peacock Rebekah K. , Perez Danielle , Pramanick Tannishtha , Ricketts Erin P. , Riggan Benji , Riser Sherry , Roosevelt Genie , Saheed Mustapha , Schumacher Sarah , Shy Bradley , Simpson Scott , Toerper Matthew F. , Trest Gil , Unsworth Madison , Waltrous Laura , Watson Brooke 
Published: January 2023

Abstract
Background
Hepatitis C (HCV) poses a major public health problem in the USA. While early identification is a critical priority, subsequent linkage to a treatment specialist is a crucial step that bridges diagnosed patients to treatment, cure, and prevention of ongoing transmission. Emergency departments (EDs) serve as an important clinical setting for HCV screening, although optimal methods of linkage-to-care for HCV-diagnosed individuals remain unknown. In this article, we describe the rationale and design of The Determining Effective Testing in Emergency Departments and Care Coordination on Treatment Outcomes (DETECT) for Hepatitis C (Hep C) Linkage-to-Care Trial.

Methods
The DETECT Hep C Linkage-to-Care Trial will be a single-center prospective comparative effectiveness randomized two-arm parallel-group superiority trial to test the effectiveness of linkage navigation and clinician referral among ED patients identified with untreated HCV with a primary hypothesis that linkage navigation plus clinician referral is superior to clinician referral alone when using treatment initiation as the primary outcome. Participants will be enrolled in the ED at Denver Health Medical Center (Denver, CO), an urban, safety-net hospital with approximately 75,000 annual adult ED visits. This trial was designed to enroll a maximum of 280 HCV RNA-positive participants with one planned interim analysis based on methods by O’Brien and Fleming. This trial will further inform the evaluation of cost effectiveness, disparities, and social determinants of health in linkage-to-care, treatment, and disease progression.

Discussion
When complete, the DETECT Hep C Linkage-to-Care Trial will significantly inform how best to perform linkage-to-care among ED patients identified with HCV.

Trial registration
ClinicalTrials.gov
ID: NCT04026867
Original date: July 1, 2019
URL: https://clinicaltrials.gov/ct2/show/NCT04026867