Large-Scale, Primary Care–Based Hepatitis C Treatment in an Urban, Medically Underserved Patient Population

Fluker, Shelly‐Ann; Darby, Rapheisha; McDaniel, Kathryn; Quairoli, Kristi; Mbonu, Collins; Kilakkathi, Sindhu; Koumtouzoua, Sarah; Jagannathan, Ram; Miller, Lesley

doi:10.1177/00333549231170205

Cited by 2 publications

(3 citation statements)

References 17 publications

(35 reference statements)

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“…Fortunately, treatment for viral hepatitis is highly effective. Across multiple US SNHs, real-world studies report high sustained virologic response (SVR) rates for directacting anti-HCV (DAA) treatment in underserved populations with significant barriers to healthcare [45,46,[49][50][51][52]. Antiviral treatment for chronic HBV in safety-net settings has also been associated with a reduced risk of cirrhosis as well as morbidity and mortality [53].…”

Section: Screening and Follow-up Of Chronic Viral Hepatitismentioning

confidence: 99%

“…According to a multicenter study of SNH patients with HBV, less than 50% of treatment-eligible patients received therapy [54]. Reported treatment rates for HCV are estimated to be at 70% at best, though a significant proportion may defer treatment due to comorbidities [49,51]. After starting HCV treatment, loss-to-follow-up and non-completion rate range from 22 to 25% [55], and the completion of post-SVR HCC surveillance remains inadequate [56].…”

Section: Screening and Follow-up Of Chronic Viral Hepatitismentioning

confidence: 99%

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Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective

Wang,

Bangaru,

Zhou

2023

Healthcare

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Safety-net hospitals (SNHs) and facilities are the cornerstone of healthcare services for the medically underserved. The burden of chronic liver disease—including end-stage manifestations of cirrhosis and liver cancer—is high and rising among populations living in poverty who primarily seek and receive care in safety-net settings. For many reasons related to social determinants of health, these individuals often present with delayed diagnoses and disease presentations, resulting in higher liver-related mortality. With recent state-based policy changes such as Medicaid expansion that impact access to insurance and critical health services, an overview of the body of literature on SNH care for chronic liver disease is timely and informative for the liver disease community. In this narrative review, we discuss controversies in the definition of a SNH and summarize the known disparities in the cascade of the care and management of common liver-related conditions: (1) steatotic liver disease, (2) liver cancer, (3) chronic viral hepatitis, and (4) cirrhosis and liver transplantation. In addition, we review the specific impact of Medicaid expansion on safety-net systems and liver disease outcomes and highlight effective provider- and system-level interventions. Lastly, we address remaining gaps and challenges to optimizing care for vulnerable populations with chronic liver disease in safety-net settings.

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Section: Screening and Follow-up Of Chronic Viral Hepatitismentioning

confidence: 99%

Section: Screening and Follow-up Of Chronic Viral Hepatitismentioning

confidence: 99%

Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective

Wang,

Bangaru,

Zhou

2023

Healthcare

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“…[8][9][10] The GLC has an effective treatment program, achieving cure rates of 97% among patients who complete HCV treatment and are tested for cure. 11 Prior to the COVID-19 pandemic, care of GLC patients consisted of one or more office visits for initial work-up by a physician or nursepractitioner, followed by three to four monthly, in-person on-treatment visits with a clinical pharmacist. 12 On-treatment visits included laboratory testing and provision of medication.…”

mentioning

confidence: 99%

A contactless cure: Leveraging telehealth to improve hepatitis C treatment at a safety‐net hospital

Frye,

Davis,

Darby

et al. 2024

Journal of Viral Hepatitis

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Hepatitis C virus (HCV) causes significant mortality worldwide. HCV is highly curable but access to care is limited for many patients. The Grady Liver Clinic (GLC), a primary care‐based HCV clinic, utilizes a multidisciplinary team to provide comprehensive care for a medically underserved patient population in Atlanta, Georgia. The GLC added a telehealth option for HCV treatment at the start of the COVID‐19 pandemic. We describe the outcomes of utilizing telehealth in this population. We performed a retrospective chart review of patients who initiated HCV treatment from March 2019 to February 2020 (pre‐pandemic) and March 2020 to February 2021 (pandemic). Charts were abstracted for patient demographics and characteristics, treatment regimen, and treatment outcomes. Our primary outcome was HCV cure rate of the pre‐pandemic compared to the pandemic cohorts and within the different pandemic cohort visit types. We performed an intention‐to‐treat (ITT) analysis for all patients who took at least one dose of a direct‐acting antiviral (DAA) regardless of therapy completion, and a per‐protocol (PP) analysis of those who completed treatment and were tested for HCV cure. SVR12 rates were >95% on ITT analysis, with no significant difference between pre‐pandemic and pandemic cohorts. There was also no significant difference within the pandemic group when treatment was provided traditionally, via telehealth, or via a hybrid of these. Our findings support the use of telehealth as a tool to expand access to HCV treatment in a medically underserved patient population.

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Large-Scale, Primary Care–Based Hepatitis C Treatment in an Urban, Medically Underserved Patient Population

Cited by 2 publications

References 17 publications

Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective

Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective

A contactless cure: Leveraging telehealth to improve hepatitis C treatment at a safety‐net hospital

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