Nurse case management to improve the hepatitis C care continuum in HIV co‐infection: Results of a randomized controlled trial

Abstract

The opportunity to eliminate hepatitis C virus (HCV) is at hand, but challenges remain that negatively influence progress through the care continuum, particularly for persons co‐infected with HIV who are not well engaged in care. We conducted a randomized controlled trial to test the effect of nurse case management (NCM) on the HCV continuum among adults co‐infected with HIV compared to usual care (UC). Primary outcomes included linkage to HCV care (attendance at an HCV practice appointment within 60 days) and time to direct‐acting antiviral (DAA) initiation (censored at 6 months). Sixty‐eight participants were enrolled (NCM n = 35; UC n = 33). Participants were 81% Black/African American, 85% received Medicaid, 46% reported illicit drug use, 41% alcohol use, and 43% had an undetectable HIV viral load. At day 60, 47% of NCM participants linked to HCV care compared to 25% of UC participants (P = .031; 95% confidence bound for difference, 3.2%‐40.9%). Few participants initiated DAAs (12% NCM; 25% UC). There was no significant difference in mean time to treatment initiation (NCM = 86 days; UC = 110 days; P = .192). Engagement in HCV care across the continuum was associated with drinking alcohol, knowing someone who cured HCV and having a higher CD4 cell count (P < .05). Our results support provision of NCM as a successful strategy to link persons co‐infected with HIV to HCV care, but interventions should persist beyond linkage to care. Capitalizing on social networks, treatment pathways for patients who drink alcohol, and integrated substance use services may help improve the HCV care continuum.

Interventions to increase linkage to care and adherence to treatment for hepatitis C among people who inject drugs: A systematic review and practical considerations from an expert panel consultation

“…(2020) RCT, cluster UK 55 randomly assigned community pharmacies Patients receiving OST in pharmacies for at least 3 months (NA; NA; 100%) Modified directly observed therapy (mDOT) in pharmacy with DAA alongside supervised OST Enhanced usual care within pharmacist pathway: HCV infection discussed with patients, testing offered if HCV status unknown, referral to treatment center offered if HCV positive Treatment initiation 112/1 365 (8%) 61/1 353 (5%) RR 1.82 [1.34, 2.46] Ward, Falade-Nwulia, et al. (2019) RCT AU, NZ 13 primary care sites (INT) and specialist based local hospitals (CON) Patients attending a primary care study site (INT: 100%; 49%; 77% / CON: 95%; 49%; 69% Hospital employed community hepatitis nurses provided HCV education, assessments, linkage to care and support whilst patients were in treatment at primary care site; general practitioners provided OST Usual care in local hospital specialist clinic; OST provided in primary care sites Treatment initiation 43/57 (75%) 18/53 (34%) RR 2.48 [1.54, 3.95] Starbird et al. (2020) RCT US Outpatient clinic for HIV and HCV care Patients from clinic providing HIV primary care and HCV specialty care (NA; 24%; 52%) Nurse case manager initiated HCV referral and assisted to schedule an appointment, discussion of barriers, reminders; HCV education (coaching participants, identify their strengths) Usual outpatient care plus HCV fact sheet Visit (at hepatitis practice within 60 days after enrolment); Treatment initiation (within 180 days) Visit: 16/34 (47%) TI: 4/34 (12%) Visit: 8/32 (25%) TI: 8/32 (25%) Visit: RR 1.88 [0.94, 3.78] TI: RR 0.47 [0.16, 1.41] Ho et al.…”

Interventions to increase appointment attendance in safety net health centers: A systematic review and meta‐analysis

“…Seven studies tested strategies in which patients received assistance from a case manager or patient navigator to manage logistical aspects of their care 17‐23 . The types of personnel used and the level of training of case managers and patient navigators varied across studies.…”

“…The types of personnel used and the level of training of case managers and patient navigators varied across studies. In three studies, nurse practitioners served as case managers 17,20,23 ; in four studies case managers did not have a clinical degree 18,19,21,22 . Three studies described specific training of patient navigators as part of the study protocol 17,18,21 .…”

“…Three studies described specific training of patient navigators as part of the study protocol 17,18,21 . Case manager/patient navigator duties varied by study and included: disease and appointment education (five studies), 18‐21,23 discussion of barriers to appointment adherence and assistance to help arrange solutions (six studies), 17,18,20‐23 making appointment reminder calls (five studies), 17,18,20,22,23 appointment anxiety management (one study), 17 accompanying patients to appointments (three studies), 17,18,21 and contacting patients to reschedule missed appointments (three studies) 17,18,22 …”

A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science

“…Achieving a sustained virologic response significantly reduces the risk of developing HCC (Ioannou et al, 2018). Nursing care coordination and case management can facilitate linkage to HCV infection treatment (Starbird et al, 2020) and treatment completion (Sherbuk et al, 2019).…”