Evaluation of a hepatitis C clinical care coordination programme’s effect on treatment initiation and cure: A surveillance‐based propensity score matching approach

Abstract

Hepatitis C (HCV) is a viral infection that if left untreated can severely damage the liver. Project INSPIRE was a 3 year HCV care coordination programme in New York City (NYC) that aimed to address barriers to treatment initiation and cure by providing patients with supportive services and health promotion. We examined whether enrolment in Project INSPIRE was associated with differences in HCV treatment and cure compared with a demographically similar group not enrolled in the programme. INSPIRE participants in 2015 were matched with a cohort of HCV-infected persons identified in the NYC surveillance registry, using full optimal matching on propensity scores and stratified by INSPIRE enrolment status. Conditional logistic regression was used to assess group differences in the two treatment outcomes. Two follow-up sensitivity analyses using individual pair-matched sets and the full unadjusted cohort were also conducted. Treatment was initiated by 72% (790/1130) of INSPIRE participants and 36% (11 960/32 819) of study-eligible controls. Among initiators, 65% (514/790) of INSPIRE participants compared with 47% (5641/11 960) of controls achieved cure. In the matched analysis, enrolment in INSPIRE increased the odds of treatment initiation (OR: 5.25, 95% CI: 4.47-6.17) and cure (OR: 2.52, 95% CI: 2.00-3.16). Results from the sensitivity analyses showed agreement with the results from the full optimal match. Participation in the HCV care coordination programme significantly increased the probability of treatment initiation and cure, demonstrating that care coordination for HCV-infected individuals improves treatment outcomes.

Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications

“…As such, it will be important to consider the implementation of evidence-based interventions that have been shown to enhance HCV testing [ 40 , 41 ], including medical chart reminders [ 40 ], dried-blood-spot testing [ 42 ], point-of-care HCV antibody testing [ 43 – 46 ], point-of-care HCV RNA testing [ 47 – 49 ], and reflex HCV RNA testing [ 50 – 52 ]. It will also be essential to implement strategies that have been demonstrated to increase treatment, including patient navigation or care coordination [ 53 – 55 ] and integration of HCV care into drug treatment settings [ 56 , 57 ]. Scale-up of evidence-based interventions to enhance HCV testing and treatment will be critical to achieve the increases in treatment uptake required to meet the WHO viral hepatitis elimination targets.…”

Innovations in Hepatitis C Screening and Treatment

“…Participants enrolled had higher rates of HCV treatment initiation (72% vs. 36%) and cure (65% vs. 47%) than patients not enrolled in INSPIRE. 99 This model increased HCV provider capacity via telemedicine for primary care providers 100 and was found to cost very few resources--only 30 patients needed to be treated at each site to break even with budgetary expenses and the cost of the intervention totaled to less than $100 per month. 101,102 Increased funding to reimburse supportive services, ability to bill and reimburse for outpatient HCV care In the two-year period from November 2013-November 2015, during the transition from interferonbased treatment to interferon-free DAA regimens, researchers in NYC tested the impact of a multifacted intervention on rates of HCV screening among baby boomers in two primary care practices.…”

“…Participants enrolled had higher rates of HCV treatment initiation (72% vs. 36%) and cure (65% vs. 47%) than patients not enrolled in Project INSPIRE. (96) This model increased HCV provider capacity via telemedicine for primary care providers (97) and was found to cost very few resources (i.e., only 30 patients needed to be treated at each site to break even with budgetary expenses, and the cost of the intervention totaled to less than $100 per month). (98,99) Increased funding to reimburse supportive services, ability to bill and reimburse for outpatient HCV care in community-based settings, elimination of DAA restrictions, and innovative payer models could help lead to wider implementation of HCV care.…”

Patient-Reported Satisfaction and Associated Changes in Health and Behavior Pre- and Post- Project INSPIRE: a Comprehensive Hepatitis C Care Coordination Program

“…As a demonstration project, INSPIRE was designed to monitor patient progress toward cure and evaluate treatment outcomes using clinical and care coordination data (9). Analysis of INSPIRE clinical outcomes has shown that participants enrolled in the program had better odds of initiating treatment and achieving SVR compared with similar HCV-infected individuals not enrolled in the program (10).…”