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Irvin R, Ntiri-Reid B, Kleinman M, Agee T, Hitt J, Anaedozie O, Arowolo T, Cassidy-Stewart H, Bush C, Wilson LE, Millman AJ, Nelson NP, Canary L, Brinkley S, Moon J, Falade-Nwulia O, Sulkowski MS, Thomas DL, Melia MT. Sharing the cure: Building primary care and public health infrastructure to improve the hepatitis C care continuum in Maryland. J Viral Hepat 2020; 27:1388-1395. [PMID: 32671942 PMCID: PMC7721959 DOI: 10.1111/jvh.13360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
In 2014, trained healthcare provider capacity was insufficient to deliver care to an estimated 70 000 persons in Maryland with chronic hepatitis C virus (HCV) infection. The goal of Maryland Community Based Programs to Test and Cure Hepatitis C, a public health implementation project, was to improve HCV treatment access by expanding the workforce. Sharing the Cure (STC) was a package of services deployed 10/1/14-9/30/18 that included enhanced information technology and public health infrastructure, primary care provider training and practice transformation. Nine primary care sites enrolled. HCV clinical outcomes were documented among individuals who presented for care at sites and met criteria for HCV testing including risk factor or birth cohort (born between 1945 and 1965) based testing. Fifty-three providers completed the STC training. STC providers identified 3237 HCV antibody-positive patients of which 2624 (81%) were RNA+. Of those HCV RNA+, 1739 (66%) were staged, 932 (36%) were prescribed treatment, 838 (32%) started treatment, 721 (27%) completed treatment and 543 (21%) achieved cure. Among 1739 patients staged, 693 (40%) patients had a liver fibrosis assessment score < F2, rendering them ineligible for treatment under Maryland Medicaid guidelines. HCV RNA testing among HCV antibody-positive people increased from 40% (baseline) to 95% among STC providers. Of 554 patients with virologic data reported, 543 (98%) achieved cure. Primary care practices can effectively serve as HCV treatment centers to expand treatment access. However, criteria by insurance providers in Maryland were a major barrier to treatment.
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Affiliation(s)
- Risha Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Boatemaa Ntiri-Reid
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Mary Kleinman
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Tracy Agee
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey Hitt
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Onyeka Anaedozie
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Tolu Arowolo
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Hope Cassidy-Stewart
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - CaSaundra Bush
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Lucy E. Wilson
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Alexander J. Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Noele P. Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauren Canary
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sherilyn Brinkley
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Juhi Moon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark S. Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David L. Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael T. Melia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Patel EU, Mehta SH, Boon D, Quinn TC, Thomas DL, Tobian AAR. Reply to MacDonald et al. Clin Infect Dis 2020; 70:544-545. [PMID: 31125394 DOI: 10.1093/cid/ciz441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Denali Boon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, Maryland
| | - David L Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kyuregyan KK, Malinnikova EY, Soboleva NV, Isaeva OV, Karlsen AA, Kichatova VS, Potemkin IA, Schibrik EV, Gadjieva OA, Bashiryan BA, Lebedeva NN, Serkov IL, Yankina A, Galli C, Mikhailov MI. Community screening for hepatitis C virus infection in a low-prevalence population. BMC Public Health 2019; 19:1038. [PMID: 31375104 PMCID: PMC6679455 DOI: 10.1186/s12889-019-7388-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Age cohort screening for hepatitis C virus (HCV) might be an effective strategy if the majority of undiagnosed cases are concentrated in a particular age group. The objective of this study was to determine HCV prevalence in different age cohorts of the general population in the Central European part of Russia and second, to assess feasibility of HCV antigen testing for community screening programs. METHODS Sera from 2027 volunteers were tested for anti-HCV (Architect Anti-HCV, Abbott Laboratories). All anti-HCV reactive samples were confirmed in an immunoblot and tested for HCV Ag (ARCHITECT HCV Ag, Abbott Laboratories), HCV RNA and HCV viral load. RESULTS Out of 31 individuals with anti-HCV reactive result, 22 (71%) were confirmed by immunoblot, six were false positives and three were indeterminate. Active infection was observed in 73% of anti-HCV confirmed positives. Five out of 16 individuals had low HCV-RNA levels (< 10,000 IU/mL) and one of those had a very low level (594 IU/mL). Agreement between HCV Ag and HCV RNA was 100%. Total anti-HCV and active HCV infection rates were 1.09% (22/2027) and 0.79% (16/2027), respectively. The peak rates were observed in people 60 years or older (anti-HCV: 2.84% [95% CI: 1.66-4.74%], 13/319; HCV RNA/HCV Ag: 2.23% [95% CI: 1.20-4.00%], 10/319). CONCLUSIONS Overall HCV prevalence is low, except in people 60 years or older. The latter should be considered as a target group for HCV screening. The high agreement between HCV RNA and HCV Ag suggests the utility of HCV Ag testing to confirm active infection in screening programs.
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Affiliation(s)
- Karen K. Kyuregyan
- Department of Viral Hepatitis, Russian Medical Academy of Continuing Professional Education, 125993 Moscow, Russia
- Mechnikov Research Institute for Vaccines and Sera, 105064 Moscow, Russia
| | - Elena Yu. Malinnikova
- Department of Viral Hepatitis, Russian Medical Academy of Continuing Professional Education, 125993 Moscow, Russia
- Mechnikov Research Institute for Vaccines and Sera, 105064 Moscow, Russia
| | | | - Olga V. Isaeva
- Department of Viral Hepatitis, Russian Medical Academy of Continuing Professional Education, 125993 Moscow, Russia
- Mechnikov Research Institute for Vaccines and Sera, 105064 Moscow, Russia
| | - Anastasia A. Karlsen
- Department of Viral Hepatitis, Russian Medical Academy of Continuing Professional Education, 125993 Moscow, Russia
- Mechnikov Research Institute for Vaccines and Sera, 105064 Moscow, Russia
| | - Vera S. Kichatova
- Department of Viral Hepatitis, Russian Medical Academy of Continuing Professional Education, 125993 Moscow, Russia
- Mechnikov Research Institute for Vaccines and Sera, 105064 Moscow, Russia
| | - Ilya A. Potemkin
- Department of Viral Hepatitis, Russian Medical Academy of Continuing Professional Education, 125993 Moscow, Russia
- Mechnikov Research Institute for Vaccines and Sera, 105064 Moscow, Russia
| | - Elena V. Schibrik
- Belgorod regional center for disease control and prevention, 308023 Belgorod, Russia
| | - Olga A. Gadjieva
- BurdenkoNational Medical Research Center of Neurosurgery, 125047 Moscow, Russia
| | - Boris A. Bashiryan
- BurdenkoNational Medical Research Center of Neurosurgery, 125047 Moscow, Russia
| | - Natalya N. Lebedeva
- Moscow Regional Center for the Prevention and Control of AIDS and Infectious Diseases, 129110 Moscow, Russia
| | - Igor L. Serkov
- Moscow Regional Center for the Prevention and Control of AIDS and Infectious Diseases, 129110 Moscow, Russia
| | - Anna Yankina
- Medical Communications, Abbott Diagnostics, 125171 Moscow, Russia
| | - Claudio Galli
- Medical Affairs Infectious Diseases, Abbott Diagnostics, 00144 Rome, Italy
| | - Mikhail I. Mikhailov
- Department of Viral Hepatitis, Russian Medical Academy of Continuing Professional Education, 125993 Moscow, Russia
- Mechnikov Research Institute for Vaccines and Sera, 105064 Moscow, Russia
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Falade-Nwulia O, McAdams-Mahmoud A, Irvin R, Niculescu A, Page KR, Mix M, Thomas DL, Sulkowski MS, Mehta SH. Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era. ACTA ACUST UNITED AC 2016; 6. [PMID: 28083156 PMCID: PMC5221662 DOI: 10.4172/2161-0711.1000481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background There are over 3 million Americans infected with hepatitis C virus (HCV). Despite recent advances in HCV treatment, a major barrier to care remains a limited number of treaters. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians. Objective To characterize current HCV care practices, willingness and self-efficacy of PCPs to become HCV treaters. Design, participants and main measures Two hundred and seventy one PCPs were identified from community clinics affiliated with a large academic center and 4 large federally qualified health centers in Baltimore, MD. An internet-based survey was administered to assess provider demographics, clinical practice site and willingness to provide HCV care. Factors associated with willingness to provide HCV care were examined using odds ratios (OR). Key results Among 129 (48%) PCPs who responded, the majority (70%) had an MD/DO degree and were white (60%). Only a few PCPs, 12 (10%), had treated at least 1 patient for HCV in the prior year. Although only 22% agreed that HCV treatment should be provided by PCPs, 84% were interested in more HCV training. Willingness to provide treatment was strongly linked to having a high proportion of HCV-infected patients (>20% versus <20%; OR 3.9; 95% confidence interval [CI] 1.5–10) and availability of other services at the primary care site including HIV treatment (OR 6.5; 95% CI 2.5–16.5), substance abuse treatment (OR 3.3; 95% CI 1.3–8.4) and mental health services (OR 4.9; 95% CI 2.0–12.1). Conclusion These data suggest that efforts to expand HCV medical provider capacity will be most impactful if they initially focus HCV training on PCPs with a high prevalence of HCV among their patients and existing systems to support HCV care.
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Affiliation(s)
| | | | - R Irvin
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - A Niculescu
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - K R Page
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Mix
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - D L Thomas
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M S Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - S H Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Irvin R, McAdams-Mahmoud A, Hickman D, Wilson J, Fenwick W, Chen I, Irvin N, Falade-Nwulia O, Sulkowski M, Chaisson R, Thomas DL, Mehta SH. Building a Community - Academic Partnership to Enhance Hepatitis C Virus Screening. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2016; 6:431. [PMID: 27525192 PMCID: PMC4982512 DOI: 10.4172/2161-0711.1000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND An estimated 3.5 million Americans are chronically infected with hepatitis C virus (HCV). However, the majority are unaware of their HCV diagnosis and few are treated. New models are required to diagnose and link HCV infected patients to HCV care. This paper describes an innovative partnership between Sisters Together and Reaching (STAR), Inc., a community organization, and Johns Hopkins University (JHU), an academic institution, for the identification of HCV cases. METHODS STAR and JHU identified a mutual interest in increasing hepatitis C screening efforts and launched an HCV screening program which was designed to enhance STAR's existing HIV efforts. STAR and JHU used the Bergen Model of Collaborative Functioning as theoretical framework for the partnership. We used descriptive statistics to characterize the study population and correlates of HCV antibody positivity were reported in univariable/multivariable logistic regression. RESULTS From July 2014 to June 2015, 325 rapid HCV antibody tests were performed in community settings with 49 (15%) positive HCV antibody tests. 33 of the 49 HCV antibody positive individuals answered questions about their HCV testing history and 42% reported a prior positive result but were not engaged in care and 58% reported that they were unaware of their HCV status. In multivariable analysis, factors that were significantly associated with screening HCV antibody positive were increasing age (AOR: 1.06, 95% CI 1.02-1.10), male sex (AOR: 5.56, 95% CI 1.92-14.29), and history of injection drug use (AOR: 39.3, 95% CI 15.20-101.49). CONCLUSIONS The community-academic partnership was successful in identifying individuals with hepatitis C infection through a synergistic collaboration. The program data suggests that community screening may improve the hepatitis C care continuum by identifying individuals unaware of their HCV status or aware of their HCV status but not engaged in care and linking them to care.
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Affiliation(s)
- R Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A McAdams-Mahmoud
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Hickman
- Sisters Together and Reaching, Incorporated, Baltimore, MD, USA
| | - J Wilson
- Sisters Together and Reaching, Incorporated, Baltimore, MD, USA
| | - W Fenwick
- Sisters Together and Reaching, Incorporated, Baltimore, MD, USA
| | - I Chen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Irvin
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Chaisson
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - DL Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - SH Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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