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Implementing a collaborative care hepatitis C virus (HCV) program aimed at targeting marginalized populations, including those imprisoned and patients with HIV, has had a big impact toward improving the cascade of care for patients with HCV.

A team, led by Wei-Wen Su, Changhua Christian Hospital, implemented a new collaborative care approach to help identify to what extent patients with HCV overlapped between and within these multiple institutions and reported the findings of treatment coverage of the marginalized populations after HCV care cascades.

HCV Elimination

There has been a major push in recent years to help eradicate HCV worldwide.

The World Health Organization (WHO) has set 2030 as a realistic target to produce an 80% reduction in incidence and an 80% increase in treatment uptake among eligible individuals.

However, treating marginalized populations, including individuals with HIV, the imprisoned, people who inject drugs, and individuals who have received opioid substation treatment, is challenging because they generally have higher rates of HCV prevalence than the general population.

Marginalized Populations

While a goal for many, it remains difficult to treat different marginalized populations with HCV.

“Treating marginalized populations with HCV infection for elimination is faced with the challenge for the integration of HCV screening service offered for patients often moving across multiple settings,” the authors wrote.

In the study, the investigators examined 7765 patients in Changhua County, Taiwan. The investigators offered HCV screening between 2019-2020 from correctional institutions, HIV clinics, methadone clinics, and the existing HIUV surveillance program, that included 4 subgroups including police-arrested people, probationers, non-injection drug user, and high-risk behavior people.

Collaborative Care

The team integrated collaborative care and information through a teamwork of gastroenterologists, psychologists, infectious disease specialists, and nursing coordinators under the authority of local health officials.

Overall, 92.65% (n = 7194) patients participated in HCV screening and the prevalence rate was the highest in methadone clinics (90.17%) followed by correctional institutions (37.67%), HIV clinics (34.60%), and the surveillance program (18.14%).

In addition, 25.41% (n = 77) of methadone clinic participants, 17.65% (n = 129) of HIV clinic patients, and various proportions for 44.09% (n = 41) of deferred prosecuted or probationers under surveillance programs were recruited into other settings.

One trend that emerged over the course of the study was that individual patient flow within the setting was more frequent than what was found between settings.

They also identified 1700 anti-HCV positives out of 4074 screenings that were traced with available follow-up information after calibrating the overlap of patient flow. This resulted in 92.52% treatment coverage of 1177 RNA-positives (77.23%) diagnosed from 1524 individuals undergoing RNA testing with similar findings across multiple settings.

“A new collaborative integrated care was adopted for elucidating patient flow between and within multiple settings in order to calibrate the accurate demand for HCV care cascades and enhance HCV treatment coverage in marginalized populations,” the authors wrote.

References:

1. Su, W.-W., Yang, C.-C., Chang, R. W.-J., Yeh, Y.-H., Yen, H.-H., Yang, C.-C., Lee, Y.-L., Liu, C.-E., Liang, S.-Y., Sung, M.-L., Ko, S.-Y., Kuo, C.-Y., Chen, S. L.-S., Yeh, Y.-P., & Hu, T.-H. (2023). A new collaborative care approach toward hepatitis C elimination in marginalized populations. Journal of Infection and Public Health. https://doi.org/10.1016/j.jiph.2023.05.019