Extension for Community Health Outcomes-hepatitis C: Small steps carve big footprints in the allocation of scarce resources for hepatitis C virus treatment to remote developing areas

Abstract

Hepatitis C virus (HCV) infection is still a major health problem throughout the world. HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions. The lack of medical resources and properly trained medical personnel in rural regions make it especially burdensome for HCV patients seeking treatment. Dr. Sanjeev Arora at the University of New Mexico Health Sciences Center took initiative to resolve the issue at hand by developing a model named Project Extension for Community Health Outcomes (ECHO). ECHO connects primary care providers (PCPs), usually family medicine physicians, in local communities with specialists. ECHO providers test the efficacy of treatment given using the ECHO model vs that at academic medical centers. The ECHO model has produced promising results such that the sustained virologic response rates for both types of sites were near-equivalent. Show Me ECHO was adapted from Project ECHO to train PCPs in Missouri and equip them with the tools and skills to properly treat and diagnose HCV in a timely manner. This healthcare model can be implemented for treating other common infections and chronic diseases. Telemedicine is the direction healthcare is headed for the next several decades. It has potential to be applied in developing countries to alleviate agony and despair resulting from limited resources and lack of access to expert medical care.

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

“…Integrated hepatitis C care within drug use and psychiatric services delivered by a multidisciplinary team with case management services, with or without non‐invasive liver disease assessment, was associated with improved hepatitis C treatment uptake . Other strategies evaluated and shown to enhance hepatitis C linkage to care and treatment include dried blood spot testing, point‐of‐care hepatitis C testing, non‐invasive liver disease screening using transient elastography (FibroScan ® ) with facilitated referral to care, integrated hepatitis C care, patient navigation programmes, peer‐based support, financial incentive programmes and telemedicine . However, the majority of interventions that have been evaluated are specific for the interferon‐era.…”

“…39 Other strategies evaluated and shown to enhance hepatitis C linkage to care and treatment include dried blood spot testing, 55 64,65 peer-based support, [66][67][68][69][70][71][72][73][74][75][76][77] financial incentive programmes 78,79 and telemedicine. [80][81][82][83] However, the majority of interventions that have been evaluated are specific for the interferon-era.…”

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

“…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). …”

Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline

“…These screening programs should be designed based on the current human resources in the public health system such as Behvarz and general practitioners (GPs). In addition, GPs can be trained for HCV therapy in targeted seminars and then they can be guided via telecommunication for more HCV therapy all over the country ( 86 ).…”