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Chief Medical Officer
Philadelphia FIGHT Community Health Centers
Division of Infectious Diseases
Perelman School of Medicine
University of Pennsylvania
Stacey Trooskin, MD, PhD, has disclosed that she has received consulting fees and funds for research support from Gilead Sciences.
Simplifying our approach to treatment makes hepatitis C treatment accessible to providers and to patients. In my opinion, hepatitis C treatment is now so simple that it’s easier to treat hepatitis C than it is to treat diabetes, or even hypertension. By following a simplified treatment algorithm, primary care providers can easily treat and cure their patients with chronic hepatitis C infection.
What Is the Simplified HCV Treatment Model?
The simplified treatment model for hepatitis C recommended by the American Association for the Study of Liver Diseases/Infectious Diseases Society of America is centered on the use of pangenotypic regimens: either glecaprevir/pibrentasvir or sofosbuvir/velpatasvir. These medications work across all genotypes.
A simplified treatment model can be used in adults with chronic hepatitis C who do not have a history of decompensated cirrhosis and have not previously been treated. Pretreatment laboratory testing is done, and then a posttreatment assessment of cure is completed 12 weeks after the end of treatment. On-treatment laboratory monitoring is not required.
Which Patients Need a Different Approach?
Some patients may need more support and more frequent follow-up. HCV treatment guidelines advise that a simplified treatment model should not be used with individuals who have previous experience with HCV treatment, have HIV or hepatitis B virus coinfection, are pregnant, have end-stage renal disease, have hepatocellular carcinoma, have current or previous decompensation, or have undergone liver transplantation.
How Can We Simplify HCV Treatment Further?
In the truest spirit, the next step to a simplified HCV treatment model is a test-and-treat model where we can diagnose somebody and begin treatment the same day. In the United States, many states still require prior authorization of HCV treatment from the payer. This means that the prescriber must submit a request to the insurance company demonstrating that the patient fits certain criteria, and then the insurance company needs to approve the medication. Turnaround time can be anywhere from 24 hours up to 2 weeks depending on how efficient the system is. For providers, that can be a barrier because it’s a lot of paperwork and red tape to navigate to get our patients treated.
We don’t need to do that for most other chronic illnesses. For example, if someone is diagnosed with hypertension, we get them started on their medicine and they pick up their prescription the same day. Although several states have already removed the need for prior authorization of HCV treatment in their Medicaid programs, this continues to complicate prescribing in many settings. Once we do away with that, we'll be getting closer to the true essence of a simplified model for everybody.
Have you implemented simplified treatment for your patients with HCV? What aspect of simplified treatment have you found most challenging in your practice? Please join the conversation and share your experiences in the comments box.