Identification and Clinical Management of Persons with Chronic Hepatitis C Virus Infection — Cherokee Nation, 2012–2015

Mera, Jorge; Vellozzi, Claudia; Hariri, Susan; Carabin, Hélène; Drevets, Douglas A.; Miller, Anna N.; Reilley, Brigg; Essex, Whitney; Gahn, David; Lyons, Lisa; Leston, Jessica; Ward, John W.

doi:10.15585/mmwr.mm6518a2

Cited by 56 publications

(44 citation statements)

References 5 publications

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“…Data examining subsequent linkage to care and curative treatment from other similar EHR‐based interventions for HCV screening of baby boomers in primary care are limited. Our rates of visits with HCV specialists and initiation on DAA therapy were higher than those of other studies: 77% newly diagnosed patients seen by specialists in the study by Goel et al and 21% and 57% of newly diagnosed patients started on DAA in the studies by Mera et al and Miller et al, respectively . While most of the newly diagnosed patients had early‐stage disease, 20.7% had evidence of either cirrhosis or advanced fibrosis at the time of initial referral.…”

Section: Discussioncontrasting

confidence: 60%

“…Our rates of visits with HCV specialists and initiation on DAA therapy were higher than those of other studies: 77% newly diagnosed patients seen by specialists in the study by Goel et al and 21% and 57% of newly diagnosed patients started on DAA in the studies by Mera et al and Miller et al, respectively. (11,27,28) While most of the newly diagnosed patients had early-stage disease, 20.7% had evidence of either cirrhosis or advanced fibrosis at the time of initial referral. These patients likely would have remained undiagnosed until they presented with decompensated liver disease had they not been screened as a result of the BPA.…”

Section: Discussionmentioning

confidence: 99%

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Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Konerman¹,

Thomson²,

Gray³

et al. 2017

Hepatology

103

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Despite effective treatment for chronic hepatitis C (CHC), deficiencies in diagnosis and access preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record (EHR) based prompt on HCV screening rates in baby boomers in primary care, and access to specialty care and treatment among those newly diagnosed. We implemented an EHR based “Best Practice Advisory” (BPA) that prompted primary care providers (PCPs) to perform HCV screening for patients seen in primary care clinic: 1) born between 1945–1965; 2) lacked a prior diagnosis of HCV infection; and 3) lacked prior documented anti-HCV testing. The BPA had associated educational materials, order set, and streamlined access to specialty care for newly diagnosed patients. Pre and post BPA screening rates were compared and care of newly diagnosed patients analyzed. In the 3 years prior to BPA implementation, 52,660 baby boomers were seen in primary care clinics, and 28% were screened. HCV screening increased from 7.6% for patients with a PCP visit in the 6 months prior to BPA to 72% over the 1-year post BPA. Of 53 newly diagnosed patients, all were referred for specialty care, 11 had advanced fibrosis or cirrhosis, 20 started treatment and 9 achieved SVR thus far. Conclusions Implementation of an EHR based prompt increased HCV screening rates among baby boomers in primary care by 5 fold due to efficiency in determining needs for HCV screening and work-flow design. Streamlined access to specialty care enabled patients with previously undiagnosed advanced disease to be cured. This intervention can be easily integrated into EHR systems to increase HCV diagnosis and linkage to care.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Konerman¹,

Thomson²,

Gray³

et al. 2017

Hepatology

103

View full text Add to dashboard Cite

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“…Ideally, a positive HCV‐antibody test automatically reflexes to HCV‐RNA testing. This approach requires a single blood collection and avoids a return visit for confirmatory testing, a major barrier in the continuum of care . Collection of dried blood spots is an option for sequential HCV‐antibody and reflex HCV‐RNA testing.…”

Section: Universal and Risk‐based Hepatitis C Screening And Follow‐upmentioning

confidence: 99%

“…This approach requires a single blood collection and avoids a return visit for confirmatory testing, a major barrier in the continuum of care. (56) Collection of dried blood spots is an option for sequential HCV-antibody and reflex HCV-RNA testing. Dried blood spot collection can be accomplished with a fingerstick rather than venepuncture, and transport does not require an intact cold chain, making this an advantageous testing option in rural areas and among people for whom phlebotomy is a testing barrier.…”

Section: Among Persons At Risk For Reinfection After Previous Spontanmentioning

confidence: 99%

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

2020

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“…Achieving HCV elimination will require sustained efforts and overcoming multiple barriers such as improving public health surveillance, increasing the number of persons who are aware of their infection and linked to care, and improving access to treatment [123•]. The Cherokee Nation of Eastern Oklahoma is the first community in the United States to develop an HCV elimination program [124]. The lessons learned from this program will be critical for identifying effective strategies and methods for reducing prevalence and incidence in communities throughout the United States.…”

Section: Continued Challengesmentioning

confidence: 99%

Hepatitis C: Review of the Epidemiology, Clinical Care, and Continued Challenges in the Direct-Acting Antiviral Era

2017

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Purpose of Review This review highlights key studies and recently published data, policies, and recommendations related to hepatitis C virus (HCV) epidemiology, transmission, and treatment. Recent Findings HCV is a leading cause of liver-related deaths, cirrhosis, and hepatocellular carcinoma. Since 2011 and accelerating since 2013, new, safe, tolerable, and curative therapies have considerably altered clinical and public health frameworks related to the prevention, control and clinical management of HCV. Nevertheless, there are several populations in the United States that are important to consider because of disparities in HCV prevalence and transmission risk. Adults born during 1945–1965 have an estimated anti-HCV antibody prevalence of ~3%, which is six times higher than among other adults, are often unaware of their infections, and are at increased risk of having HCV-associated morbidity and mortality from decades of chronic infection. Since the early 2000s, increasing incidence of acute HCV infections among young, white, non-urban people who inject drugs have been reported. Despite promising therapeutic advances, significant challenges remain for reducing HCV-associated morbidity and mortality. Summary The high burden of HCV and significant health consequences associated with chronic infection make HCV a critical public health priority. Advances in HCV treatment have created new opportunities for reducing HCV-associated morbidity and mortality. These treatments are safe, well-tolerated, and highly effective; however, benefits cannot be realized without a significant increase in the number of persons tested for HCV so that all chronically infected individuals can be aware of their diagnosis and linked to appropriate clinical care.

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Identification and Clinical Management of Persons with Chronic Hepatitis C Virus Infection — Cherokee Nation, 2012–2015

Cited by 56 publications

References 5 publications

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

Hepatitis C: Review of the Epidemiology, Clinical Care, and Continued Challenges in the Direct-Acting Antiviral Era

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