Hepatologists’ role in HCV care, elimination ‘remains one of advocacy’

WASHINGTON — A leading expert in hepatology called for fellow specialists to embrace a role of education, advocacy and support as part of a proposed national hepatitis C virus elimination program presented during The Liver Meeting.

“Our role now is really in support of the primary care practitioner, because we all know that transfer of patient from diagnosis to treatment results in losses, that we have individuals who don’t complete the cascade of care,” Norah Terrault, MD, MPH, professor of medicine and Neil Kaplowitz Chair in Liver Diseases at the University of Southern California Keck School of Medicine, told attendees. “We have simple diagnostics, simple therapies. This really belongs in the hands of our primary care providers.”

During an expert-led panel discussion, Terrault noted that hepatologists and infectious disease specialists have traditionally served as primary care givers for patients with HCV. But now, with the advent of direct-acting antivirals and easy-to-access guidelines for diagnosis and treatment, she said the specialists’ role must shift, although hepatologists should continue to treat patients with additional complications and comorbidities.

“There are still individuals who are going to have comorbidities that are maybe just beyond the comfort level of our primary care providers,” she said. “There are still patients who present for the first time with their infection as a decompensated patient, a patient with liver cancer. We have patients who are post-transplant. That is our wheelhouse and that is where we will continue to lead in terms of treatment.”

According to Terrault, specialists also should serve as partners in multidisciplinary teams and work with primary care providers in an educational role.

“As educators, our role is also in training these new treaters,” she said. “We have a very, very important role of educator and then, within that, capacity builders ... if we’re really doing that job of educating in the right way, supporting and training our primary care providers.”

Lastly, Terrault emphasized hepatologists’ role as advocates in the creation of new models of care that shift treatment and management to primary care providers.

“Our role is to be partners in those new models of care,” she said. “Because we’ve been in this game a long time and we see when this does not happen: when a patient doesn’t get diagnosed, doesn’t get linked to care and doesn’t get treatment, we know what happens. We’re seeing the cancers and the decompensated disease.”

She continued, “Our role remains one of advocacy: advocacy of this program, advocacy in our communities and advocacy within AASLD.”

PULLQUOTE:

“When a patient doesn’t get diagnosed, doesn’t get linked to care and doesn’t get treatment, we know what happens. We’re seeing the cancers and the decompensated disease.”