An expanding role for primary care providers in the treatment of hepatitis C virus infection in the community

Abstract

Deming P, Kalish-man S, Dion D, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl Abstract The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology , the ECHO program trains primary care providers to treat complex diseases. We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response. A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, À9.2 to 10.7; P ¼ 0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P ¼ 0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites. The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat.

Uptake of hepatitis C treatment among people who inject drugs attending Needle and Syringe Programs in Australia, 1999–2011

“…lack of referral, centralization of treatment within tertiary care) . However, many of these factors are modifiable and potentially alleviated by integrated models of HCV treatment and care that move beyond hospital‐based specialist clinics .…”

Identification of Hidden Key Hepatitis C Populations: An Evaluation of Screening Practices Using Mixed Epidemiological Methods

“…The number of treated persons will even be lower because not every specialist is certified to provide HCV treatment and not all patients are eligible for treatment. Earlier studies have indicated that it is important to increase awareness among GPs concerning HCV treatment and referral possibilities [18], [34], [35].…”

What Is Killing People with Hepatitis C Virus Infection?

“…However, successful strategies to improve engagement with HCV services and enhance HCV assessment have been explored. 21 One model to enhance access to HCV care for underserved populations focused on the integration of community-based health centers in New Mexico using state-of-the-art telehealth technology to provide training and support for primary care providers to deliver best-practice HCV care. 87 This model was effective, with similar responses to HCV treatment observed among community-based clinics as compared with a university-based hospital.…”