Sharing the cure: Building primary care and public health infrastructure to improve the hepatitis C care continuum in Maryland

Risha Irvin, Boatemaa Ntiri-Reid, Mary Kleinman, Tracy Agee, Jeffrey Hitt, Onyeka Anaedozie, Tolu Arowolo, Hope Cassidy-Stewart, Ca Saundra Bush, Lucy E. Wilson, Alexander J. Millman, Noele P. Nelson, Lauren Canary, Sherilyn Brinkley, Juhi Moon, Oluwaseun Falade-Nwulia, Mark S. Sulkowski, David L. Thomas, Michael T. Melia

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1388-1395
Number of pages8
JournalJournal of viral hepatitis
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2020

Keywords

  • hepatitis c
  • hepatitis c care continuum
  • provider task shifting
  • public health
  • video conference training

ASJC Scopus subject areas

  • Hepatology
  • Infectious Diseases
  • Virology

Fingerprint Dive into the research topics of 'Sharing the cure: Building primary care and public health infrastructure to improve the hepatitis C care continuum in Maryland'. Together they form a unique fingerprint.

Cite this