Study Looks at Philadelphia Community-Based Hepatitis C Screening Program

A Philadelphia program operating in underserved neighborhoods found that residents chronically infected with the hepatitis C virus often lacked access to screening as well as treatment for the disease.

A Feb. 14 online article in the Journal of General Internal Medicine looks at the findings of a study of the Do One Thing program in which expert advocates visited a medically underserved area where there are high rates of hepatitis C among the population there. The advocates helped vulnerable patients work around barriers that kept the residents from getting care, the study found.

Models are scarce for scaling screening and treatment of the 3 million or more Americans estimated to have hepatitis C, especially for those with limited or no access to medical services according to Amy Nunn, ScD, MS, assistant professor of behavioral and social sciences at Brown University and co-author of the study.In a Brown University news release, she notes that new methods of testing for hepatitis C in addition to new and better medications provide great opportunity to cure the millions living with the disease.

“Our paper proves that scaling screening and treatment, even in neighborhoods with the highest rates of infection, is possible,” states Nunn. “We overcame all the commonly cited obstacles in this high risk population.”

The study’s objective was to implement and evaluate hepatitis C screening and interventions that linked patients to care in a community setting.

The Do One Thing program, which began in December 2012, brought together a team of volunteers and physicians, phlebotomists, patient advocates and social workers to operate a neighborhood door-to-door campaign to screen for hepatitis C. Using a mobile medical unit, the team performed rapid screening tests and took immediate blood draws for confirmatory lab work from participants who tested positive.

The program included comprehensive services that guided patients with confirmed chronic hepatitis C infection to help them gain health insurance, access to medical specialists and treatment to cure the disease, the release states. The results show how important community-based testing efforts can be to identify people who didn’t know they have the virus and also help those aware of their diagnosis but not getting care, said Stacey Trooskin, MD, of Drexel University College of Medicine, lead author of the study and member of the program team.

Of the 1301 people that the team had tested in a little more than a year, 3.9% had hepatitis C antibodies, which was higher than Philadelphia’s citywide rates, according to the study abstract. Only four out of the 52 people who tested positive in the initial screening were already undergoing care for the virus.

“Although hepatitis C is now a curable disease, we identified new barriers to care such as the need for a referral to subspecialty care and challenges obtaining medication approval for patients, particularly those covered under Medicaid,” said Trooskin.

The author abstract states that “the biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64 percent of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment.”

Unanticipated challenges included time the staff spent “haggling with payers about coverage for the drug,” said Nunn.

“With the advent of new medications that can cure hepatitis C, we have created a culture of urgency about staying in care and cure,” Nunn said. “This model works because the very same person that delivers your confirmatory test is the person that holds your hand all the way to cure.”

Study authors concluded that screening programs with patient navigator services are an effective means to diagnose, link, retain, and re-engage patients who need care for the hepatitis C virus. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with the virus.