Hepatitis C, Chronic
Conditions
Keywords
cascade of care
Brief summary
Several factors are barriers to effective Hepatitis C care: 1) The majority of Hepatitis C Virus (HCV)-positive patients (45-85 percent) are unaware that they are infected; 2) Only a small minority of those in need of treatment receive it; 3) Members of minorities and older patients are even less likely to receive needed care; and 4) Until recently, even those who were treated had a low chance of clearing the virus or achieving cure; 5) It is possible that older attitudes and expectation of futility might continue to persist among patients and provider in primary care settings. Community Health Centers are often the most culturally appropriate and accessible choices, particularly for underserved populations, with the benefit of ongoing trust and relationships with patients. Therefore, these can be ideal places to deliver complex HCV care if they possess the needed expertise. However, most community-based primary care and community health centers lack access to Hepatitis C evaluation and treatment services, leading to a major public health problem. Thus, investigators propose to implement and evaluate a pragmatic trial to implement and evaluate a multi-disciplinary model for HCV treatment at Currently, the treatment initiation rates at each of these sites is estimated as less than 10%. The investigators hypothesize that our project will increase the rate of participation in all the steps of the HCV care cascade and ultimately lead to more than doubled rates of treatment uptake
Detailed description
Primary Objective: Determine uptake, effectiveness and safety of IFN-free, DAAs among real world patients, including those with multiple comorbidities, in the primary care setting. Secondary Objective(s): 1. Demonstrate the transformation of the cascade of Hepatitis C Care at 3 primary care clinics in terms of changes from baseline in rates for rates of access to HCV care including HCV screening, evaluation, treatment consideration, treatment uptake, completion, loss to follow-up, and treatment success rate. 2. Advance understanding of hepatitis C related decision-making in the era of Interferon (IFN)-free Direct acting agents (DAAs) by examining the context, needs, motivators, barriers, and preferences among patients and providers to the delivery of hepatitis C treatment at primary care clinics
Interventions
None listed
Sponsors
University of Pittsburgh
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* All patients with detectable HCV RNA level, currently receiving care at any of these three community health centers
Exclusion criteria
* Criteria for automatic specialty referral (exclusion from treatment at community health centers) Child Turcotte Pugh Class B or C Any history of decompensated liver disease or hepatocellular carcinoma Evidence of renal disease (GFR \<50) or coexisting autoimmune condition HIV of hepatitis B co-infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of patients achieving sustained viral response 12 weeks post treatment (SVR 12) over a three year intervention period. | three years | measure percentage of patients moving through the cascade of care to cure of condition (SVR 12) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Chronic Hepatitis C evaluation | three years | Percentage of patients with a positive HCV antibody test who have a HCV polymerase chain reaction (PCR) viral load completed |
| Rate of treatment consideration | three years | Percentage of consented patients with a positive HCV viral load who have a clinical evaluation and assessment of psychosocial readiness for treatment documented in the medical record |
| Rate of treatment uptake | three years | Percentage of patients recommended for treatment who begin medical treatment |
| Rates of Hepatitis C Virus (HCV) screening | three years | Percentage of at risk patients in the practice who have a completed HCV antibody test |
| Rate of patients lost to follow up | three years | Percent of consented patients with a positive HCV viral load who are lost to follow up |
| Hepatitis C capacity building among family medicine physicians (provider practice and perceived confidence): | three years | Endpoints related to HCV capacity building among family medicine physicians: Evaluate comfort and skill among family physicians to evaluate and treat HCV infection as measured on a qualitative survey of physicians |
| Rate of treatment completion | three years | Percentage of patients that began treatment who complete the recommended course of therapy |
Countries
United States
Outcome results
None listed