Accelerating The Hepatitis C Care Cascade For Patients With Substance Use

Author: Rienstra J, Schiller K, Battle R, Chantrill A, Iwasaki J

Theme: Models of Care Year: 2018

Hepatitis C Virus (HCV) has a disproportionate impact on the American Indian/Alaskan
Native (AI/AN) population, particularly those with substance use disorders. Eighty
percent of patients screened for HCV have current or historic substance use. This same
population also suffers from housing insecurity, complex medical and mental health
diagnosis, high rates of incarceration, and inconsistent transportation, requiring the
development of an innovative screening and treatment strategy that accelerates the
traditional HCV care cascade.
Description of model of care:
HCV screening is offered at our Opioid Treatment Program (OTP) and Syringe Service
Program (SSP) ensuring access to care for highest risk patients. If a patient screens
positive, the care cascade begins with same day HCV RNA reflex to genotype,
Fibroscan and meeting with case managers. The case managers address barriers to
care and make connections to social services. The case is then presented to project
ECHO, and within two office visits the patient can start treatment. Our two case
managers make phone calls, perform home visits, coordinate treatment with corrections
facilities, provide transportation, and may coordinate medication co-administration at the
1,861of 5,775 (32%) adults have been screened, including 188 of 331 (57%) OTP
patients. 151 patient have chronic HCV, of which 77 (51%) have been treated and
achieved sustained virologic response. Since incorporating Fibroscan in 2018, 12 of 30
(40%) HCV evaluated patients were ready to treat after one visit. The average patient
requires 10 separate interventions from our case managers to complete treatment.
Aligning treatment programs to each patient’s unique and evolving lifestyle has resulted
in 100% treatment success.
With multidisciplinary collaboration, onsite Fibroscan, patient engagement in developing
care delivery plans, and fostering a therapeutic environment for those with addiction,
HCV elimination becomes a realistic possibility at our clinic by 2020.
Disclosure of Interest Statement:

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