Dr. Lesley Miller (2019)
Dr. Miller built a program in an urban hospital setting treating 500 patients annually with a cure rate of 98%.
"As a hepatitis C (HCV) treater since 2004, I have had the privilege of being part of a revolution in HCV care over the course of my career. I am thrilled that we can now talk about HCV in the context of elimination. My path in advocacy toward HCV elimination started with the development of a novel HCV care delivery model, the Grady Liver Clinic (GLC). The GLC is a primary care-based HCV clinic that provides comprehensive care, including treatment, for urban, underserved patients at Grady Health System in Atlanta, GA. The GLC program started by providing critical access to HCV treatment on a small scale in the heart of the interferon era, and has grown dramatically with the introduction of targeted HCV screening efforts and the availability of new antivirals. With an expanded program and staffing, we now treat close to 500 patients annually and cure 98%.
Implementation of routine HCV screening has been a cornerstone of our elimination program. We launched our program by screening baby boomers in Grady’s Primary Care Center, and based on a high disease prevalence, continued to expand routine HCV screening to Grady’s Neighborhood Health Centers, specialty clinics, inpatient wards and Emergency Department. Key features of the screening program included electronic health record automation with a screening prompt, provider education, and robust linkage to care made possible by patient navigators and our easily accessible, onsite Liver Clinic. Through these efforts, we have screened almost 34,000 patients and revealed a 9% HCV antibody prevalence and achieved close to a 70% linkage to care rate.
In addition to screening and treatment, we have sought other innovative strategies to reach our elimination goals. We partnered with the CDC to create an HCV registry at Grady Health System which allowed us to analyze gaps in our care cascade and implement solutions to close those gaps. One gap we identified was lack of confirmatory HCV RNA testing for all positive HCV antibody tests, so we worked with our in-house laboratory to implement reflex HCV RNA testing, an intervention that successfully closed that gap.
As we disseminated the results of our successful screening and treatment programs, other sites interested in launching HCV care programs began to approach us for advice and training. Through a combination of training workshops and site visits, I have had the opportunity to help implement tailored HCV screening and treatment programs regionally in Georgia. I have trained two programs in Savannah, GA, St. Mary’s Health Center and St. Joseph’s Candler Health System, where I helped develop clinical protocols, shared educational and patient care materials, and performed on-site trainings. Facilitated by Georgia’s State Viral Hepatitis Prevention Coordinator, I have given several trainings aimed at bringing together providers from both local and rural programs who are interested in ramping up HCV treatment capacity. One of the most exciting outcomes of this effort is that a nurse-run substance use treatment program in Athens, GA with a high prevalence of hepatitis C and no treatment sites to refer patients to attended my workshop and immediately went home and started their first patients on treatment. They have now cured 12 patients. I have also held trainings at local clinics providing substance use disorder treatment in an effort to expand the capabilities of providers to treat their clients with HCV onsite.
Through all of these efforts, we are moving closer every day to meeting HCV elimination goals. Next steps include novel outreach strategies for difficult to reach populations, continued vigilance in screening and treatment, and expanded efforts to grow the workforce of HCV treaters."