A Regional Analysis of Hepatitis C Virus Collaborative Care With Pharmacists in Indian Health Service Facilities

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A Regional Analysis of Hepatitis C Virus Collaborative Care With Pharmacists in Indian Health Service Facilities

Authors

Geiger, R.,Steinert, J.,McElwee, G.,Carver, J.,Montanez, R.,Niewoehner, J.,Clark, C.,Reilley, B.

 

Citation
2018
Journal of primary care & community health

9

1-5
Type
Retrospective cohort
Virus targets
Hepatitis C
Interventions
HCV testing and linkage to Care
Linkage to care
Screening and diagnosis
Testing
Setting
National
Target populations
General Population
Country of development
United States of America
Target location
United States of America
DOI
10.1177/2150132718807520
Testing strategy
Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test
Laboratory-based antibody test
Laboratory-based PCR/RNA (confirmatory) test
Countries of included studies
United States of America

Health outcomes

Linkage to care,Loss to follow-up cascade

Testing strategy

Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test

Abstract

BACKGROUND: American Indian/Alaska Natives (AI/ANs) are disproportionately affected by hepatitis C virus (HCV), with more than double the national rate of HCV-related mortality as well as the highest rates of acute HCV. The "cascade of care" for HCV consists of screening, confirmation, treatment, and sustained virologic clearance (SVR)/cure. At each stage of this process, patients can be lost to follow-up. Federal health care facilities in an administrative area of the Indian Health Service conducted a review to identify and address gaps in HCV treatment. Facilities generally treated HCV with a strong pharmacy component using a collaborative practice agreement and HCV telehealth services to external specialists. METHOD(S): All facilities had a pharmacist HCV program point of contact. Each pharmacist conducted a chart review of HCV patients and submitted aggregate results on HCV antibody status, HCV confirmation testing, stage of liver disease, initiation of treatment, and SVR/cure. Each facility also ranked current barriers to scaling up HCV treatment services from a defined list of options. RESULT(S): Of 1789 HCV antibody positive patients, 77% (1381) had a confirmation test, of which 67% (929) were positive. Of these patients, 62% (576) had their liver fibrosis scored, and 58% (335) had initiated treatment. Of patients with an SVR/cure test, all (274/274) were negative. DISCUSSION: These data indicate that rural clinics can be successful providing HCV diagnosis and treatment. Pharmacists can play a key role in HCV clinical services. The outcomes of each step in the treatment process at the facility level can vary widely due to local factors. The barriers to HCV care that persist are nonclinical.

Page updated

22 Jan 2021