Patient Navigation Increases Linkage to Care and Receipt of Direct-acting Antiviral Therapy in Patients with Hepatitis C

Strebe, Joslyn K.; Rich, Nicole E.; Wang, Li; Singal, Amit G.; McBryde, Jennifer; Silva, Mauro Ramalho; Jackson, Victoria; Fullington, Hannah; Villarreal, Deyaun L.; Reyes, Stephanie; Flores, Belinda T.; Jain, Mamta

doi:10.1016/j.cgh.2022.04.031

Cited by 13 publications

(7 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this scenario, multiple strategies were identified to improve health care for people at high risk of hepatitis C infection ( 23 ). Patient guardianship has been associated with significantly increased adherence at the beginning and follow-up of treatment among patients with HCV infection compared to the standard of care in a randomized study, which included 1,353 patients (769 in the usual care group and 584 in the patient care group, respectively) ( 24 ). The guardianship group had significantly higher probabilities of adherence to care and initiation of treatment within the first 6 months.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers

Corona-Mata

Rivero‐Juárez

Camacho

et al. 2023

Front. Public Health

View full text Add to dashboard Cite

Background and aimsThe burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population.MethodsSix-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response.ResultsOf the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma.ConclusionsOur study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers

Corona-Mata

Rivero‐Juárez

Camacho

et al. 2023

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…A recent analysis of 1353 patients (62% Black, 61% uninsured, 16% without homes) born between 1945 and 1965 and newly diagnosed with HCV at a Dallas safety net health system used a prepost implementation design to assess the impact of patient navigation on access to care and HCV treatment initiation. Among 584 in the patient navigation group, access to HCV evaluation and treatment (OR, 3.7 [95% CI, 2.9-4.8]) and treatment initiation within 6 months (OR, 3.2 [95% CI, 2.3-4.2]) were higher compared with 769 patients in the usual care group …”

Section: Discussionmentioning

confidence: 99%

Hepatitis C in Black Individuals in the US

Falade-Nwulia,

Kelly,

Amanor-Boadu

et al. 2023

JAMA

View full text Add to dashboard Cite

ImportanceIn the US, the prevalence of hepatitis C virus (HCV) is 1.8% among people who are Black and 0.8% among people who are not Black. Mortality rates due to HCV are 5.01/100 000 among people who are Black and 2.98/100 000 among people who are White.ObservationsWhile people of all races and ethnicities experienced increased rates of incident HCV between 2015 and 2021, Black individuals experienced the largest percentage increase of 0.3 to 1.4/100 000 (367%) compared with 1.8 to 2.7/100 000 among American Indian/Alaska Native (50%), 0.3 to 0.9/100 000 among Hispanic (200%), and 0.9 to 1.6/100 000 among White (78%) populations. Among 47 687 persons diagnosed with HCV in 2019-2020, including 37 877 (79%) covered by Medicaid (7666 Black and 24 374 White individuals), 23.5% of Black people and 23.7% of White people with Medicaid insurance initiated HCV treatment. Strategies to increase HCV screening include electronic health record prompts for universal HCV screening, which increased screening tests from 2052/month to 4169/month in an outpatient setting. Awareness of HCV status can be increased through point-of-care testing in community-based settings, which was associated with increased likelihood of receiving HCV test results compared with referral for testing off-site (69% on-site vs 19% off-site, P &lt; .001). Access to HCV care can be facilitated by patient navigation, in which an individual is assigned to work with a patient to help them access care and treatments; this was associated with greater likelihood of HCV care access (odds ratio, 3.7 [95% CI, 2.9-4.8]) and treatment initiation within 6 months (odds ratio, 3.2 [95% CI, 2.3-4.2]) in a public health system providing health care to individuals regardless of their insurance status or ability to pay compared with usual care. Eliminating Medicaid’s HCV treatment restrictions, including removal of a requirement for advanced fibrosis or a specialist prescriber, was associated with increased treatment rates from 2.4 persons per month to 72.3 persons per month in a retrospective study of 10 336 adults with HCV with no significant difference by race (526/1388 [37.8%] for Black vs 2706/8277 [32.6%] for White patients; adjusted odds ratio, 1.02 [95% CI, 0.8-1.3]).Conclusions and RelevanceIn the US, the prevalence of HCV is higher in people who are Black than in people who are not Black. Point-of-care HCV tests, patient navigation, electronic health record prompts, and unrestricted access to HCV treatment in community-based settings have potential to increase diagnosis and treatment of HCV and improve outcomes in people who are Black.

show abstract

“…To address this issue, program partners should consider introducing additional activities directed at more integrated care of hepatitis C and TB and interventions targeted at retaining patients in hepatitis C care. These interventions could include patient navigators that have been found effective in hepatitis C linkage to care, [45] or providing hepatitis C treatment in the same facilities where they receive TB treatment. Additionally, patients with MDR TB could be treated for HCV infection and TB concomitantly.…”

Section: Discussionmentioning

confidence: 99%

“…care. These interventions could include patient navigators that have been found effective in hepatitis C linkage to care, [45] or providing hepatitis C treatment in the same facilities where they receive TB treatment. Additionally, patients with MDR TB could be treated for HCV infection and TB concomitantly.…”

Section: Care Of Hepatitis C and Tb And Interventions Targeted At Ret...mentioning

confidence: 99%

Hepatitis C care cascade among patients with and without tuberculosis: findings from nationwide programs in the country of Georgia, 2015-2020

Baliashvili

Blumberg

Gandhi

et al. 2022

Preprint

View full text Add to dashboard Cite

Background The Eastern European country of Georgia initiated a nationwide hepatitis C virus (HCV) elimination program in 2015 to address a high burden of infection. Screening for HCV infection through antibody testing was integrated into multiple existing programs, including the National Tuberculosis Program (NTP). We sought to evaluate loss to follow-up (LTFU) from the hepatitis C care cascade among persons diagnosed with active tuberculosis (TB) disease. Methods Using national ID numbers, we merged databases of the HCV elimination program, NTP, and national death registry from January 1, 2015, to September 30, 2020. We estimated the proportion of patients with and without TB who were LTFU at each step of the HCV care cascade and explored temporal changes. Results Among 11,985 patients with active TB, 9,065 (76%) were tested for HCV antibodies, and 1,665 (18%) had a positive result; LTFU from hepatitis C care was common, with 20% of patients with a positive antibody test not undergoing viremia testing, and 43% of patients with viremia not starting treatment for hepatitis C. Overall, among persons with confirmed viremic HCV infection, only 28% of patients with TB had a documented cure from HCV infection, compared to 55% among patients without TB. LTFU after positive antibody testing substantially decreased in the last three years, from 32% among patients diagnosed with TB in 2017 to 12% among those diagnosed in 2019. Conclusions LTFU from hepatitis C care after a positive antibody or viremia test was high and more common among patients with TB than in those without TB. Better integration of TB and hepatitis C care systems can potentially reduce LTFU and improve patient outcomes. Existing large-scale programs for both TB and hepatitis C in Georgia create a unique opportunity for such integration to contribute to hepatitis C elimination efforts.

show abstract

Patient Navigation Increases Linkage to Care and Receipt of Direct-acting Antiviral Therapy in Patients with Hepatitis C

Cited by 13 publications

References 24 publications

Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers

Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers

Hepatitis C in Black Individuals in the US

Hepatitis C care cascade among patients with and without tuberculosis: findings from nationwide programs in the country of Georgia, 2015-2020

Contact Info

Product

Resources

About