A decline in the HIV workforce has led to a crisis of insufficient expertise to manage people with HIV (PWH), roughly a quarter of whom are coinfected with hepatitis C. Task shifting to nonspecialist providers can contribute to solving the HIV workforce shortage problem, but nonspecialist providers require sufficient training and support to acquire and retain the necessary knowledge and skills. Digital tools including mobile applications (apps) and telementoring which utilizes telecommunication technology for education and skill acquisition can be used for professional development. Described is the development and dissemination of a mobile app specifically for providers managing HIV/HCV coinfection in the United States. The app, through provider professional development, facilitates access to curative HCV treatment in PWH, encourages integration of HCV care into primary care and contributes to national goals to eliminate HIV and viral hepatitis by 2030.
BackgroundHIV and HCV infection cause considerable morbidity and mortality if untreated. The southern United States has the highest burden of new HIV diagnoses nationwide. Approximately 60% of hepatocellular carcinoma (HCC) in the United States is due to HCV. HCC incidence rates are the fastest growing among all cancers in Texas (TX). We aimed to use community screening events to provide additional diagnostic opportunities and surveillance data for HIV/HCV and to evaluate an HIV/HCV app to optimize public health education and prevention.MethodsTwo community HIV/HCV screening/education events occurred in April 2019 in the border city of Laredo, TX (at a community park) and San Antonio, TX (on a university campus). Those screened for HIV/HCV using point of care rapid tests completed a demographic and risk factor questionnaire. HIV/HCV education was offered to attendees via an app with a teach-back feature to assess short-term knowledge gains in specific areas: HIV and HCV cure, body organ impacted by HCV, HCV transmission, HCV symptoms.ResultsAttendees: Laredo event—approximately 260 people; San Antonio event approximately 100 people. 60 people were screened for HIV and HCV. 77% were Hispanic, 63% were female, 68% were 18–25 years old, 63% reported not having a primary care provider. One HCV seroreactive case was identified and linked to care. The most commonly reported risk factors were having tattoos (43%) and body piercing (37%). Other risk factors included street drug use (12%), home finger stick blood checks (12%), dental surgery outside the United States (12%). Fifty-three people utilized the HIV/HCV education app. 91% correctly identified that HIV cannot be cured, 87% correctly identified that HCV impacts the liver and that a test can confirm HCV infection. 81% correctly identified how HCV can be transmitted and 79% corrected identified that HCV can be cured. The app was rated 4.8/5, as “very useful” on a Likert scale.ConclusionFeatures of those screened included not being engaged in primary care, having risk factors for both HCV and HIV infection and the majority being young adults. The HIV/HCV mobile phone app was an acceptable education tool for those who utilized it. Appropriately developed and implemented apps can be effective in teaching key knowledge points about HIV/HCV infection.Disclosures All authors: No reported disclosures.
The treatment and cure of hepatitis C (HCV) in people with HIV is particularly important as progression of their liver disease is quicker compared with those who have HCV monoinfection. Innovative approaches are needed to maximize access to curative HCV treatment. Integration of HCV care into HIV primary care with education and support of nonspecialist providers via telementoring offers a solution to specialist workforce shortages. Using focus group qualitative methodology, health care workers’ perspectives regarding this approach, particularly with the Extension for Community Healthcare Outcomes (ECHO) telementoring model, were obtained and are described. Successful integration of HCV care into HIV primary care has demonstrated benefits to patients, including allowing them to remain in their medical home for care. Factors beyond disease that influence their health and wellbeing must also be considered.
Direct-acting antivirals are overwhelmingly effective in curing hepatitis C (HCV). Barriers to HCV treatment exist for those co-infected with both HIV and HCV. Southern states represent the epicenter of the HIV epidemic in the United States. This study assessed HCV knowledge, attitudes, and perceptions in 318 co-infected individuals attending Ryan White HIV/AIDS Program (RWHAP) clinics in three South Texas cities. Two groups were compared, those tested for HCV and aware of their results (Group 1) and those uncertain if they were tested or tested and unaware of their results (Group 2). HCV knowledge was poor overall. Group 1 had a significantly higher mean HCV knowledge score than Group 2 by t-test (48.6 vs. 38.8; p < .01), but not by multivariable linear regression (p=.14). Factors predictive of greater HCV knowledge included self-identification as lesbian, gay, bisexual, transgender, queer and post high school educational attainment. Significantly more in Group 1 compared with Group 2 agreed that HCV medications would keep a person healthier for longer. Spanish speakers were more likely to disagree with a statement that people of color receive the same treatment for hepatitis C as white people. Study limitations identified include poor generalizability to people with HIV (PWH) receiving care in non-RWHAP settings and rural communities. Despite limitations, this study augments the paucity of information about knowledge, attitudes, and perceptions of HCV in PWH and can inform interventions to combat barriers to HCV treatment and to maximize opportunities for HCV screening, diagnosis, and linkage to curative care.
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