Limited provider treatment expertise and specialist access for hepatitis C virus (HCV) are well-documented barriers to HCV treatment. To address this need, in April 2013 the Florida/Caribbean AIDS Education and Training Center (F/C AETC) initiated an HCV-focused program modeled after the Extension for Community Healthcare Outcomes (Project ECHO) improving the capacity for primary care providers to manage and treat HCV infection. F/C AETC’s HIV-HCV Project ECHO (ECHO clinic) is a biweekly videoconferencing forum where primary care clinicians present their patient cases to interdisciplinary specialists who provide advice and clinical mentoring. The primary care clinic team at Memorial Healthcare System participated in the ECHO clinics from their inception and utilized F/C AETC specialist advice to guide the care of HCV-infected patients.
De-identified patient cases were submitted to the F/C AETC in advance of each ECHO clinic. Following a brief didactic presentation, experts reviewed the patient cases with a focus on pertinent labs, comorbidities, drug interactions with HCV treatment, side effects, adherence, social barriers, and navigating third-party payers. The primary care clinic team – a physician, a nurse, and a clinical pharmacist – has attended ECHO clinics since April 2013 and initiated HCV treatment in February 2014.
Between February 2014 and April 2015, a total of 31 patients initiated HCV treatment. HCV patient demographics are as follows: 67% genotype 1 HCV, 65% co-infected with HIV, 77% received 12-weeks of treatment. The most common treatment initiated was sofosbuvir/ledipasvir (39%), followed by sofosbuvir + ribavirin (29%). Of 31 patients, 20 patients completed treatment, 10 patients are currently receiving treatment, and 1 patient discontinued treatment due to a treatment-related side effect. A sustained virologic response (SVR) was achieved in 100% (n=17) of patients in on treatment analysis; SVR results are pending in 3 additional patients.
The primary care clinic at Memorial Healthcare System successfully engaged with the ECHO telemedicine clinic, achieving positive clinical outcomes, expanding community healthcare services, and building capacity for primary care clinic teams treating HCV infection.
P. Eckardt, None
A. Savage, None
D. Jayaweera, None
J. Beal, None