An Evaluation of Hepatitis C Virus Telehealth Services Serving Tribal Communities: Patterns of Usage, Evolving Needs, and Barriers

Abstract

Introduction: American Indian/Alaska Native (AI/AN) populations are disproportionately affected by chronic hepatitis C virus (HCV) infection. Federal facilities of the Indian Health Service, in conjunction with Tribally operated and Urban Indian (I/T/U) health care facilities, serve an estimated 2.2 million AI/AN patients. The facilities are mainly rural and have few specialists. To fill the gap in specialists in I/T/U clinics, the Extension for Community Healthcare Outcomes (ECHO) telehealth model was used to support clinicians to treat HCV in primary care. Methods: Participants in 3 regional HCV ECHO networks serving AI/AN patients were surveyed by e-mail and text message to determine patterns of ECHO usage, usefulness, and barriers to treating patients with HCV at their primary care clinics. Results: From a total of 44 respondents from 72 eligible health care facilities, a majority (61%) stated that they started treating patients with HCV subsequent to participating in the telehealth program. Participants with more telehealth experience sought increasing complexity in patient case presentations. In California, 7 of 8 clinicians who had attended more than 10 ECHO sessions expressed diminishing need for ECHO sessions to manage cases (<25% of patients). All elements of the ECHO sessions (presenting patient cases, listening to patient case presentations, teaching sessions, and sharing of programmatic insights) were considered “extremely useful” by the majority of respondents. The factors most cited as moderate or extensive barriers to providing HCV care were access to HCV direct acting antivirals (60%) and linking patients to care (50%). Discussion: Extension for Community Healthcare Outcomes may play a key role not only in increasing clinical capacity for HCV treatment but also in the inception of HCV services in this sample of I/T/U facilities. Participants with more telehealth experience demonstrated signs of increasing clinical capacity, where they were more likely to seek complex patient case presentations in ECHO sessions. A number of barriers continue to keep AI/ANs from being cured and stop clinicians from ending the epidemic, including access to HCV medications, time to provide HCV clinical services, and linking patients to HCV services.

Evaluation of treatment access and scope of a multistate hepatitis C virus Extension for Community Healthcare Outcomes telehealth service in the US Indian Health System, 2017‐2021

“…A survey of 44 clinicians who participated in Indian Country ECHO cited that the continued barriers to HCV treatment were lack of access to HCV medications, need for more frequent/regular access to specialists, difficulty getting patients into care/follow-up, and limited clinical time for HCV. 25 Access to HCV treatment medication was noted as a…”

“…25 and at least one of the following: platelet counts less than 150,000/mm3 , FibroSure®/FibroTest result indicating cirrhosis, or imaging results demonstrating cirrhosis. Patients with cirrhosis were compared to patients without fibrosis and patients with indeterminant fibrosis.…”

Can Telemedicine Optimize the HCV Care Cascade in People Who Use Drugs? Features of an Innovative Decentralization Model and Comparison with Other Micro-Elimination Strategies

“…Telemedicine-based models have been used more frequently in other settings to optimize the care cascade for HCV-infected patients [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Recently, independent studies have shown how the support of telemedicine improve the access and management of antiviral treatment in the Department of Corrections, optimizing therapy effectiveness [ 47 , 48 , 49 , 50 , 51 , 52 , 53 ].…”

“…Similarly, telemedicine has also been successfully used to implement the HCV care cascade in remote areas, where the usual management and treatment models would have meant significant logistical difficulties, long waiting times, and high costs [ 54 , 55 , 56 , 57 , 58 ].…”

Telemedicine in Hepatology: Current Applications and Future Directions

“…Because of a variety of social and geographical factors (eg, marginalization of patients with chronic hepatitis C, a high prevalence of hepatitis C in prisoners, limited access to specialty care in traditionally medically underserved communities), treatment of chronic hepatitis C has historically been challenging. ( 13,14 ) According to the World Health Organization, an estimated 71 million people have chronic hepatitis C; however, of those diagnosed with hepatitis C, only 5 million have been treated with direct‐acting antivirals by the end of 2017. ( 15 ) It is believed that a primary reason for the discrepancy in the number of patients with chronic hepatitis C and the number of patients receiving treatment is the lack of access to treatment in many parts of the world.…”