Public health clinic‐based hepatitis C testing and linkage to care in baltimore

Falade‐Nwulia, Oluwaseun; Mehta, Shruti H.; Lasola, Jackline Joy; Latkin, Carl A.; Niculescu, Alexander B.; O’Connor, Casey M.; Chaulk, Patrick; Ghanem, Khalil G.; Page, Kathleen R.; Sulkowski, Mark S.; Thomas, David L.

doi:10.1111/jvh.12507

Cited by 54 publications

(59 citation statements)

References 37 publications

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“…Simplified HCV testing, including dried blood spot testing (McAllister et al, 2014) and point-of-care HCV testing (Bottero et al, 2015; Morano et al, 2014) has been shown to facilitate linkage to HCV care. Other strategies that have been demonstrated to facilitate linkage to HCV care and treatment include, non-invasive liver disease screening using transient elastography (FibroScan ® ) with facilitated referral to care (Foucher et al, 2009; Marshall et al, 2015; Moessner et al, 2011), integrated HCV care (Cullen et al, 2006; Evon et al, 2011; Ho et al, 2015; Knott et al, 2006; Masson et al, 2013; Zhou et al, 2016), patient navigation programs (Falade-Nwulia et al, 2016; Trooskin et al, 2015), and telemedicine (Arora et al, 2011; Lloyd et al, 2013; Mashru, Kirlew, Saginur, & Schreiber, 2017; Tahan, Almashhrawi, Kahveci, Mutrux, & Ibdah, 2016). …”

Section: Linkage To Hcv Care and Treatmentmentioning

confidence: 99%

Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs

Grebely

Bruneau

Lazarus

et al. 2017

International Journal of Drug Policy

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Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7. 5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection.

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Section: Linkage To Hcv Care and Treatmentmentioning

confidence: 99%

Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs

Grebely

Bruneau

Lazarus

et al. 2017

International Journal of Drug Policy

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“…Better outcomes were found among opioid users undergoing substance abuse treatment, where 71% of persons with chronic HCV infection initiated treatment . In addition, a study in a Baltimore sexually transmitted infections clinic found high linkage to care rates among persons who were referred to off‐site specialists, with the assistance of patient navigation …”

mentioning

confidence: 99%

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

Coyle

Moorman

Bartholomew³

et al. 2019

Hepatology

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Improving care and treatment for persons infected with hepatitis C virus (HCV) can reduce HCV‐related morbidity and mortality. Our primary objective was to examine the HCV care continuum among patients receiving care at five federally qualified health centers (FQHCs) in Philadelphia, PA, where a testing and linkage to care program had been established. Among the five FQHCs, one served a homeless population, two served public housing residents, one served a majority Hispanic population, and the last, a “test and treat” site, also provided HCV treatment to patients. We analyzed data from electronic health records of patients tested for HCV antibody from 2012 to 2016 and calculated the percentage of patients across nine steps of the HCV care continuum ranging from diagnosis to cure. We further explored factors associated with successful patient navigation through two steps of the continuum using multivariable logistic regression. Of 885 chronically infected patients, 92.2% received their RNA‐positive result, 82.7% were referred to an HCV provider, 69.4% were medically evaluated by the provider, 55.3% underwent liver disease staging, 15.0% initiated treatment, 12.0% completed treatment, 8.7% were assessed for sustained virologic response (SVR), and 8.0% achieved SVR. Regression results revealed that test and treat site patients were significantly more likely to be medically evaluated (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.82‐4.17) and to undergo liver disease staging (aOR, 1.92; 95% CI, 1.02‐2.86) than patients at the other FQHCs combined. Conclusion: In this US urban setting, over two thirds of HCV‐infected patients were linked to care; although treatment uptake was low overall, it was highest at the test and treat site; scaling up treatment services in HCV testing settings will be vital to improve the HCV care continuum.

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“…In this sample of primary care providers in a region with high HCV prevalence [9,17–19], a large proportion of PCPs were aware of new HCV treatments and agreed that treatment would benefit the communities they serve. However, only 22% of PCPs agreed that in the era of interferon-free, direct-acting regimens, HCV treatment should be provided by PCPs, and they were statistically more likely to have a high prevalence of HCV and have patient support services in their clinics.…”

Section: Discussionmentioning

confidence: 99%

“…This has led to significant delays in or failure of HCV care linkage due to a combination of patient and provider level factors including long specialist wait times or lack of willingness by patients to attend HCV care appointments at alternate venues [6,9]. Newly approved and highly effective direct acting antivirals (DAA) make it possible for HCV to be cured with low patient and provider burden and has raised the possibility of HCV elimination in the US [10].…”

Section: Introductionmentioning

confidence: 99%

Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era

Falade‐Nwulia¹,

McAdams-Mahmoud²,

Irvin³

et al. 2016

J Community Med Health Educ

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BackgroundThere are over 3 million Americans infected with hepatitis C virus (HCV). Despite recent advances in HCV treatment, a major barrier to care remains a limited number of treaters. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians.ObjectiveTo characterize current HCV care practices, willingness and self-efficacy of PCPs to become HCV treaters.Design, participants and main measuresTwo hundred and seventy one PCPs were identified from community clinics affiliated with a large academic center and 4 large federally qualified health centers in Baltimore, MD. An internet-based survey was administered to assess provider demographics, clinical practice site and willingness to provide HCV care. Factors associated with willingness to provide HCV care were examined using odds ratios (OR).Key resultsAmong 129 (48%) PCPs who responded, the majority (70%) had an MD/DO degree and were white (60%). Only a few PCPs, 12 (10%), had treated at least 1 patient for HCV in the prior year. Although only 22% agreed that HCV treatment should be provided by PCPs, 84% were interested in more HCV training. Willingness to provide treatment was strongly linked to having a high proportion of HCV-infected patients (>20% versus <20%; OR 3.9; 95% confidence interval [CI] 1.5–10) and availability of other services at the primary care site including HIV treatment (OR 6.5; 95% CI 2.5–16.5), substance abuse treatment (OR 3.3; 95% CI 1.3–8.4) and mental health services (OR 4.9; 95% CI 2.0–12.1).ConclusionThese data suggest that efforts to expand HCV medical provider capacity will be most impactful if they initially focus HCV training on PCPs with a high prevalence of HCV among their patients and existing systems to support HCV care.

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Public health clinic‐based hepatitis C testing and linkage to care in baltimore

Cited by 54 publications

References 37 publications

Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs

Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era

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