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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.
Despite the availability of curative treatments for hepatitis C, many people with hepatitis C virus (HCV) infection in the United States remain undiagnosed and untreated. Simplified management algorithms aim to reduce barriers to care by making HCV treatment more accessible to healthcare professionals and patients.
Simplified HCV Screening
In the United States, it is now recommended that HCV screening should be offered to everybody who is aged 18 years or older. This move to universal testing reduces the stigma associated with screening for HCV based on risk factors and addresses some of the complexity that was involved in screening individuals based on birth cohort. By screening all adults for hepatitis C, we are more likely to identify individuals with undiagnosed infections.
The easiest and simplest way to screen for hepatitis C is to use HCV antibody testing that automatically links to confirmatory viral load testing, referred to as “reflex testing.” With just one phlebotomy stick, we can obtain the information necessary to make a diagnosis of chronic HCV infection. The laboratory will first run an HCV antibody test on the sample, and if it is reactive, then the laboratory will run a nucleic acid amplification test. Without reflex testing, individuals would have their blood drawn for an antibody test and then those with a positive result would need to come back in for a second visit to get a confirmatory test. Unfortunately, we would lose a lot of patients along the way. The availability of reflex testing simplifies this step to diagnosis and is critical to engaging patients in care.
A One-Stop Shop for HCV Care
The easiest way to link people to HCV care is to embed the care where the patient already receives other services. Integrating HCV treatment into a primary care setting, a substance use disorder treatment setting, or a harm reduction setting provides a patient-centered approach to treatment and leads to higher rates of uptake.
At Philadelphia FIGHT community health centers, which are federally qualified health centers, we provide primary care and have implemented electronic medical record modifications that allow us to screen all of our new patients with HCV reflex testing. Approximately 30% to 40% of our patients have a history of substance use disorder and are either actively using drugs or in recovery. Because we have a very high–risk population, we screen individuals annually for HCV using reflex testing as part of our routine care. Linkage to HCV care at Philadelphia FIGHT is also simple for patients who test positive outside of our health center; as a federally qualified health center, we are able to see uninsured patients. We take care of whomever walks through the door, and we can provide our patients with both primary care and hepatitis C care.
We found that one-stop shopping is a very low barrier model that is critical for patients. We offer behavioral health services and treatment for substance use disorder. We have on-site laboratory services so that patients are not required to leave the premises to get their blood drawn. We have medical case managers on site, and an on-site pharmacist to help with medication and adherence counselling. We try to provide everything a patient needs.
Taking hepatitis C treatment is now so simple that, in my opinion, it is easier to treat HCV than diabetes, or even hypertension, in some cases. By following simplified management guidelines, primary care professionals can easily diagnose and treat HCV, and the less we require patients to navigate complex healthcare systems with referrals to subspecialty care, the more likely they are going to be to engage in HCV treatment.
Have you changed or do you plan to change your practice to simplify HCV treatment? What are the greatest barriers to keeping patients with HCV in care that you have encountered? Please join the conversation and share your experiences in the comments box.
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