Curing HCV at Mount Sinai in Patients at High Risk of Disease Progression: HCV/HIV Co-infection and Type 2 Diabetes, New Solutions to the Challenge of Eliminating HCV - New York City, US
Health outcomes additional info
Other healthcare outcomes: Engagement in the healthcare system
Performance target additional info
This program seeks to target adults with HIV/HCV coinfection and adults with HCV and type 2 diabetes.
Other performance indicators to the ones indicated above include: Prospective enrollment of HIV/HCV co-infected patients in a study of the impact of HCV cure on indicators of systemic inflammation
To date, over 500 people have been engaged in the HCV care coordination pipeline.
Goals: To engage 500 HIV/HCV co-infected patients in HCV care by Jan 1, 2021 and engage 200 HCV/type 2 diabetic patients in HCV care by Jan 1, 2021.
Summary and objectives
Primary Scientific Objective:
To develop, operationalize, and evaluate a novel, proactive Care Model that has the following components:
- An innovative suite of custom software that will be developed and applied to EMR data to greatly enhance HCV case finding.
- Patient navigators to make appointments and speed HCV medication approvals, coordinate care, in-cluding linkage to care and HCV treatment.
Secondary Scientific Objectives:
1. To determine the impact of HCV cure on markers of systemic inflammation, diabetes, and hepatic disease.
- Measure the impact of HCV cure on a marker of systemic inflammation, soluble CD163, in HIV/HCV- co-infected patients. Elevated levels of soluble CD163 are independently associated with mortality in HIV-infected patients and are especially high in patients with HIV/HCV coinfection. If HCV cure reduces inflammation, as expected, this will potentially confer a global health benefit that may lead to greater longevity. - Measure improvement in diabetes management (e.g., changes in HOMA-IR, glucose, use of diabetic medications) in patients with type 2 diabetes.
2. To use next-generation sequencing to identify resistance associated variants (RAVs) among patients who fail HCV treatment or become re-infected and to use these data to inform the selection of the treatment regimen to be used in any subsequent round of treatment and to identify patients who may benefit from counseling about risk reduction practices.
More about this program:
This project was started on December 12, 2017.
Challenges include: Difficulty reaching patients (by phone) who have a screened positive for HCV RNA; incomplete medical records
Other members of the team include Douglas Dieterich, Ponni Perumalswami, Amreen Dinani, Li Li, Maxence Vandromme, Alyson Harty, Anna Mageras, Mark Miller,Frank Eng, and Brooke Wyatt.