Integration of Hepatitis C Treatment in a Primary care Federally Qualified Health Center; Philadelphia, Pennsylvania, 2015-2017

Abstract

Hepatitis C virus (HCV) infection remains a pressing public health issue. Identification of long term infection in primary care settings and community health centers can facilitate patients’ access to appropriate care. Given the increase in HCV prevalence in the United States, improving the HCV care continuum and expanding medication access to disproportionately affected populations can help reduce disease burden, health care system costs, and transmission. Innovative treatment programs developed in the primary care setting are needed to deliver quality care to meet the demand of those engaging in treatment. This article describes an HCV treatment program developed within a primary care federally qualified health center (FQHC) using physician assistants (PAs) and nurse practitioners (NPs) to address the high number of HCV positive patients identified at the clinic. An interdisciplinary care team was established to optimize patient experience around HCV care and treatment, using on-site primary care behavioral health consultants, an HCV treatment coordinator, and a 340B contracted specialty pharmacy. From January 2015 to April 2017, the Public Health Management Corporation (PHMC) Care Clinic medical providers referred 189 patients for HCV treatment. Of those referred, 102 patients successfully obtained a sustained virologic response (SVR), representing a 53.7% success rate from referral to cure. This treatment program successfully integrated HCV treatment in a patient population heavily affected by substance use and mental illness. Support and adoption of similar programs in primary care community health centers testing for HCV can help meet the clinical/behavioral needs of these marginalized populations.

Evaluation of Risk Factors for Hepatitis C Virus Infection Among Philadelphia's Shelter-Bound, Homeless Population: Data from a Student-Run Hepatitis C Virus Screening Initiative

“…A novel interdisciplinary approach to HCV screening and treatment in a Philadelphia primary care Federally Qualified Health Center showed a 53.7% success rate from referral to virologic cure through the use of primary care providers, on-site behavioral health, treatment coordinators, and a 340B contracted specialty pharmacy. 24 The transition to treating HCV-positive patients in the primary care setting rather than in gastroenterology or infectious disease subspecialty practices provides benefit of decreasing both transitions of care where patients may be lost to follow-up and the clinical burden on expensive subspecialty practices.…”

A Structural Competency Curriculum for Primary Care Providers to Address the Opioid Use Disorder, HIV, and Hepatitis C Syndemic

“…Although there have been successful models of care integration for management of HIV and OUD, these have largely been in specialty care settings and there has been inadequate uptake in primary care practices (21). Similarly, while there have been successful models of HCV integration into primary care (22)(23)(24), including increasing consideration for OUD (25), such comprehensive approaches remain underutilized.…”

Patient Centeredness in Hepatitis C Direct-Acting Antiviral Treatment Delivery to People Who Inject Drugs: A Scoping Review

“…Seventeen studies modified clinical practices to integrate HCV treatment. Integration was implemented in primary care facilities [31,33,[50][51][52][53][54], SAM services [28,29,34,35,55], syringe exchange programs [56], HIV clinics [57,58], community pharmacies [25], and prisons [30].…”

“…Clinical Visits Follow-up support to ensure adherence was the most addressed component within this dimension (19 studies). This follow-up was offered by providers [31,33,37,39,40,42,43,45,46,48,[50][51][52]58] as well as peer support groups [26,53,56]. One study triaged the patients into different levels of support according to their risk of non-adherence and patients who did not complete treatment were offered intensive follow-up home visits by peers [57].…”

“…Coordinating treatment plans was implemented by linking HCV services with medical and social services in [23, 25, 27-30, 38, 39, 43, 49, 58] 11 Specific relevance of patient centeredness to treatment outcomes [26, 28-37, 39, 41-43, 45, 47, 50-57] two studies [33,39], mental health and SAM services in three studies [35,40,51], specialty pharmacy [43], and other organizations for medication support [31].…”