Federal Centers Crucial for Hepatitis C Continuum of Care

Mohamed Zakarya, MD

Federally qualified health centers are beneficial for patients who need to receive the full allotment of treatment for hepatitis C viral (HCV) infections.

A team, led by Mohamed Zakarya, MD, Stamford Hospital and Columbia University College of Physicians and Surgeons, identified treatment barriers among HCV-infected patients at Optimus Health Centers in Connecticut in data presented at the annual American College of Gastroenterology (2020) conference.

Treatment for HCV is currently accessible, inexpensive, and overall as effective as it has ever been.

However, a large number of infected individuals can either go undetected because of suboptimal screening practices or untreated because of patient, provider, and system barriers.

The investigators conducted a chart review of patients tested for HCV antibodies between January and June 2019. They then referred confirmed cases to network primary care providers trained in HCV diagnosis and treatment.

These cases were tracked for posttest follow-up until sustained virologic response was achieved.

The barriers to follow-up and treatment were identified using cause-and-effect methods and included patients’ insurance status, low health literacy, low socioeconomic status and cultural orientation, competing health priorities, scheduling conflicts, lack of HCV patients’ representatives, lack of structured reminders and incentives, and incarcerations.

The investigators also designed and implemented a number of interventions that began in July 2019, including enrolling patients in a subsidized treatment plan through federal 340B savings, posttest harm-reduction counseling with patients and their caregivers, providing a treatment cascade plan for every patient that encompasses HCV care continuum until reaching SVR, appointing HCV patient facilitator for weekly follow-up calls, and appointments accommodation.

In phase 2 of the program, the investigators performed a chart review of patients tested for HCV antibodies between July 1, 2019 and February 29, 2020 and tracked confirmed cases for posttest follow-up until sustained virologic response was achieved using a chi-squared test to analyze results.

Overall, the rate of confirmed hepatitis C infections remained stable pre- and post-intervention (3%) of total tested patients (2597 and 3046, respectively). The pre-intervention treatment rate was 63% (n = 44) compared to 95% (n = 77) post intervention (P <0.0001).

“This investigation shows the suboptimal baseline follow-up and treatment rates of HCV patients in federally qualified health centers,” the authors wrote. “Our post-intervention findings highlight the impact and effectiveness of providing support services to assist patients throughout the HCV care continuum in order to achieve high rate adherence to therapy and thus reducing morbidity and mortality as well as overall cost.”

Earlier this year, researchers found direct-acting antivirals (DAA) could be the answer in treating patients with HCV infections, regardless of whether they also suffer from cirrhosis.

DAA treatment was associated with a decrease in mortality among Medicare beneficiaries with or without cirrhosis, suggesting that increasing access to DAA drugs for all patients with HCV infection, regardless of disease progression, could improve population health.

The study, “Improving Hepatitis C Virus Treatment Rates at Federally Qualified Health Centers,” was published online by ACG.