431. Lessons learned from HIV: creating a hepatitis C linkage to care program
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Background: Hepatitis C (HCV) affects over 3 million people in the United States and approximately 19,300 people died from HCV-related complications in 2013. New Direct Acting Agents (DAA) have made HCV a curable disease without the morbidity associated with previous anti-virals. We identified systemic and individual barriers to accessing HCV medical care, used insights from HIV navigation models to establish linkage to care and wraparound services for our community members living with HCV.

Methods:Mt. Sinai Hospital is on the west side of Chicago in a community that has been disproportionately impacted by HIV and HCV. In 2014, we piloted a HCV navigation program which links and retains HCV-infected patients to care. We identified several systemic barriers to care for HCV patients, including insufficient 
(1) rates of HCV confirmatory testing, 
(2) referrals for liver staging and outpatient clinic visits, and
(3) capacity for submitting prior authorization (PA) for HCV treatment.

Our program identified individual barriers to care, including
(1) substance use 
(2) housing 
(3) transportation
(4) mental health issues

Results: In the first year we navigated 209 patients diagnosed with HCV. By streamlining our screening algorithms to better identify HCV patients, our health system increased confirmatory testing from 50% to 100%. Because of these efforts and our partnership with an external agency, we referred 141 patients for FibroScan (Echoscans, Cambridge, MA) liver staging and linked 147 patients to their first outpatient clinic visit. Our navigator and pharmacist submitted 50 PA requests to insurance companies for HCV treatment and 41 patients have been treated for HCV. To achieve these outcomes, our navigator conducted needs assessments on each patient and made appropriate referrals to substance use programs, insurance navigators, medical transit and outpatient mental health providers.

Conclusion:Understanding the importance of linkage and retention in care for HIV-infected patients has allowed our program to create a parallel system for HCV-infected patients. Implementing effective and sustainable solutions to systemic and individual barriers to care in our community has created the backbone of a successful program. We believe this approach is reproducible in similar resource-poor settings.

Nancy Glick, MD1, Hilary Armstrong, MPH2, Audra Tobin, BA2 and Kristi Allgood, MPH3, (1)Infectious Diseases, Mount Sinai Hospital, Chicago, IL, (2)Internal Medicine, Mt. Sinai Hospital, Chicago, IL, (3)Suhi, Mt. Sinai Hospital, Chicago, IL


N. Glick, Gilead: Scientific Advisor and Speaker's Bureau , Consulting fee and Grant recipient

H. Armstrong, None

A. Tobin, None

K. Allgood, None

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