Bringing hepatitis C treatment into the medical home

Wednesday, June 1, 2016
Pavilion Ballroom (Hilton Portland)
Joanna Eveland, MS, MD, AAHIVM, ABAM (Clinical Chief for Special Populations, Mission Neighborhood Health Center)
Introduction: In 2014, Mission Neighborhood Health Center (MNHC) began to offer community-based Hepatitis C (HCV) treatment through a pilot program. The objective of our HCV pilot is to provide a multidisciplinary treatment program in a primary care setting, increasing HCV treatment access while evaluating outcomes. A focus of the pilot is creating a treatment model to successfully engage and serve active drug users and those who are marginally housed.

Background: Current Hepatitis C Virus (HCV) treatments are safe, well tolerated and have cure rates upwards of 90 percent. Historically, only five to six percent of HCV-positive individuals have been successfully cured due to multiple barriers to treatment. In San Francisco, access to HCV treatment is limited, especially for those with active substance use or mental illness. MNHC’s HIV Care Team already facilitates high rates of engagement in care and treatment adherence for a complex patient population. Community-based HCV treatment is patient-centered, brings new patients motivated by HCV treatment into primary care, improves patient self-efficacy, and is satisfying for providers. Patients with active substance use disorders may encounter less stigma and greater treatment access in the community setting.

Methods: The MNHC HCV pilot offers HCV treatment utilizing a successful multi-disciplinary model previously reserved for persons living with HIV. We provide outreach coordination, health education, case management, substance use counseling, treatment access and adherence support. The pilot includes both HCV mono-infected and HIV/HCV co-infected patients. Initial treatment was via an internal referral to MNHCs HIV clinic. We have now expanded to also offer on-site HCV treatment at our homeless clinic.

Outcomes: To date, 81 patients have been evaluated for treatment, and 68 of those 81 have been found to be stable for treatment. Forty-one patients have received formal HCV education by the health educator. Nineteen patients are currently engaged in the treatment process, while 26 patients have completed treatment. Twenty-five of 26 patients who completed treatment achieved a successful outcome, and none of those 26 patients have experienced reinfection. On phone survey, patients reported high satisfaction with all components of the program.

Conclusions: We have found that successful HCV treatment for complex patient populations is achievable in the community-based clinical setting. With support, active substance users can engage in HCV care, adhere to treatment and make a plan to avoid reinfection. A multidisciplinary model facilitates treatment readiness and contributes to positive outcomes. We learned that current treatments are well tolerated and stable patients require minimal support to complete therapy. However, accessing treatment authorization is time intensive and requires dedicated support. Some patients believe that HCV treatment is unnecessary, toxic, or cost prohibitive. More education is needed for patients and providers.