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HCV, HIV co-clinic reaches hard-to-treat population
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Establishing a co-located hepatitis C virus clinic within an HIV clinic successfully managed co-infected patients — a typically hard-to-treat population — resulting in HCV treatment initiation in 70.5% of participants and an SVR at 12 weeks post-treatment or cure in 56.1% of patients, according to a study.
“Among the 1.2 [million] persons living with HIV in the United States, 25% are coinfected with HCV,” Christina Rizk, MD, statistician in the HIV/AIDS Program at Yale University School of Medicine, and colleagues wrote. “The availability of effective direct antiviral agents (DAAs) makes the goal of HCV elimination feasible, but implementation requires improvements to the HCV treatment cascade, especially linkage to and initiation of treatment in underserved populations.”
Rizk and colleagues conducted a retrospective review, following 173 treatment-naive patients with chronic HCV infection receiving care at a university-affiliated hospital-based HIV clinic in New Haven, Connecticut, between Jan. 1, 2014, and March 31, 2017.
“This model consists of a dedicated management team that includes a cadre of HCV-trained infectious disease prescribers, a mid-level provider, nurse, specialty pharmacy staff and data support staff,” Rizk and colleagues wrote. “The team met regularly to monitor progress and provide flexible and innovative approaches to facilitate engagement in HCV care.”
Of the patients, 80.9% were aged 50 to 70 years, 66.5% were male, 57.2% were African American, 24.9% were white and 13.3% were Hispanic, according to Rizk and colleagues. Their comorbidities included cirrhosis (25.4%), kidney disease (17.3%), mental health issues (60.7%), alcohol abuse (30.6%) and active drug use (54.3%).
According to the study, 93.1% of patients were referred to a DAA prescriber, 85% were linked to a prescriber, 70.5% were prescribed DAAs and 56.1% experienced SVR12. Comparing patients with SVR12 and those unsuccessfully referred, linked or treated, the researchers found that among those not engaged in HCV care, there was a higher proportion of younger, female patients and a higher frequency of missed appointments.
“Establishing a co-located HCV clinic within an HIV clinic model has been successful in facilitating pretreatment evaluation in 93.1% of coinfected patients with overall SVR12 documented in 56.1% of patients (79.5% of treated patients). This compares favorably with published national HCV treatment cascades in mono-infected patients,” the authors wrote. “Of the 22.5% of patients who were not successfully started on treatment, ongoing issues included lack of engagement in health care. Targeted assessment of patient and provider barriers to completing clinicwide HCV micro-elimination and novel approaches for promoting engagement in care are needed.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Gitanjali Pai, MD, AAHIVS
With the large global as well as national burden of HCV, it is of utmost importance to address HCV, especially in underserved populations as we inch forward toward pursuing the WHO’s goal of global HCV elimination by 2030. The advent of highly effective as well as shorter duration of therapy, with fairly universal access to DAAs, has not only simplified HCV therapy but made it more appealing to patients with a quicker “turnaround time.” However, implementation and engagement in HCV care remain a much larger challenge.
This study by Rizk and colleagues underscores the importance of intense interdisciplinary collaboration to achieve the targets of engaging higher numbers of the HIV/HCV coinfected population in HCV care. Simplifying logistics for connectivity and retention within the health care system is a key factor in getting patients on board with HCV management, including further monitoring and surveillance, especially in an already socially challenged population such as with those with HIV, with a high HCV coinfection rate (estimated nationally at 25%) at the outset. Proactively requesting referrals involves concentrated time and effort but eventually becomes a win-win situation for all, including the provider and the patient. The novel use of technology to monitor patient adherence and promote patient participation in treatment is promising and warrants further exploration, especially in subsets of the population at a higher risk for noncompliance.
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