Successful Implementation of a Shared Medical Appointment Model for Hepatitis C Treatment at a Community Health Center

Abstract

Highly efficacious direct acting antiviral (DAA) therapy for treatment of Hepatitis C Virus (HCV) infection is largely inaccessible to communities facing a shortage of available specialist providers. Though less demanding than previous interferon regimens, DAA therapy requires patients to adhere to 8-12 weeks of daily treatment, which can be challenging for some patient populations. Duffy Health Center, located on Cape Cod, Massachusetts, provides integrated medical, mental health and case management services to people who are homeless or at risk for homelessness. The goal of this manuscript is to evaluate the outcomes of treatment of HCV infection with a shared medical appointment (SMA) model. The primary outcome was sustained virologic response (SVR-12), or HCV RNA ≤ 15 IU/mL at 12 weeks post-treatment. There were 102 patients recruited, with a total of 104 treatments administered. Over three-fourths of patients who attended one SMA visit (78 of 102) continued in SMA for the duration of treatment. Of these patients opting for SMA, 99% (77 of 78) completed the full treatment course, and 91% (71 of 78) of SMA patients achieved SVR-12. DAA therapy provided by non-specialist providers using the SMA model yielded comparable response rates to those achieved by specialist providers, and has the potential to substantially increase access to HCV treatment for patient populations within high-risk communities.

A qualitative investigation of organizational challenges and facilitators to screening individuals experiencing homelessness for hepatitis C virus (HCV) in Houston, Texas

“…Previous studies have reported challenges in providing referrals, and this breakdown in collaboration and information sharing is a significant challenge to providing information, education, and access to HCV screening to individuals experiencing homelessness [ 13 ]. Because clients at both the social services organizations and their neighboring clinic partners overlap, a commitment to innovative, full integration can prove highly effective in increasing HCV screening and treatment, as researchers have shown in past studies [ 16 , 17 ]. Future studies should consider exploring the wide spectrum and variability of integration approaches within community-based organizations.…”

“…Ending the HCV epidemic requires expanding the type of providers who screen for, diagnose, and treat HCV to include those in non-traditional, community settings [ 16 , 17 ]. Community organizations can effectively screen, diagnose, navigate high-risk individuals into care, and retain them in HCV care [ 18 ].…”

“…Community organizations can effectively screen, diagnose, navigate high-risk individuals into care, and retain them in HCV care [ 18 ]. Screening for HCV in community settings can also help reach individuals who are disengaged from medical care in a way that is relevant to their circumstances [ 16 , 19 ]. Alternative settings for HCV screening have helped improve community awareness and identify individuals who were unaware of their HCV infection or aware of their HCV infection but not connected to treatment [ 17 ].…”

Large-Scale, Primary Care–Based Hepatitis C Treatment in an Urban, Medically Underserved Patient Population

“…Since 2002, several primary care-based HCV programs have been described. 7,8,[17][18][19][20][21][22] Compared with these programs, the GLC is one of the oldest and single-site primary care-based HCV treatment programs in the United States. Several factors played a role in the longevity and growth of the GLC.…”

“…Several studies have described effective HCV management by primary care providers in various settings. [7][8][9][17][18][19][20][21][22] As such, in settings where there are leadership champions for elimination of HCV, various strategies can be used to identify, link, and navigate patients to cure of HCV infection.…”