The Implementation of a Novel, Multidisciplinary Hepatitis C Program in an Established HIV Program

Background:

There is limited access to specialist care for hepatitis C (HCV) infection in Delaware. To meet this need, we created a program to provide dedicated HCV care within an existing HIV Program, adopting the Ryan White HIV care model to provide comprehensive care through a multi-disciplinary team.

Methods:

The Christiana Care HIV Community Program, the only Ryan White-funded HIV treatment program in Delaware, cares for over 1,650 patients living with HIV. In March 2014, we expanded access to those with HCV through the creation of a HCV Program that includes a dedicated administrative assistant, nurse, nurse practitioner, pharmacist, and 2 board-certified Infectious Diseases physicians. We performed a retrospective chart review of all patients evaluated in the HCV Program from March 2014 through May 13, 2016. We evaluated demographics, sources of HCV care referrals, and HCV disease and treatment status.

Results:

89 individuals entered care with 34 (38%) prescribed HCV treatment (Figure 1). The majority of patients are male, born between 1945 and 1965, with genotype 1a or 1b (Table). 55 patients entered care but have not received HCV treatment (Figure 2). Of 27 treatment initiations, 13 (48%) patients have completed treatment, 11 of these 13 (85%) have achieved cure, and 14 are receiving treatment (Figures 1, 3).

Table: Patient Characteristics

Characteristic	N (%) n = 89
Sex Male	57 (64)
Age 18-25 26-50 51-71	3 (4) 19 (21) 67 (75)
Referral Source Internal providers Community providers Department of Corrections Substance abuse treatment facility Self-referral	33 (37) 31 (35) 13 (14) 6 (7) 6 (7)
Fibrosis Stage F0 F1 F2 F3 F4 Pending Not required	10 (11) 9 (10) 16 (18) 11 (12) 19 (22) 16 (18) 8 (9)

Conclusion:

The creation of a HCV Program within an established Ryan-White funded HIV program in an urban environment is a novel HCV care model. Treatment outcomes emphasize that implementation of components of a comprehensive HIV program, namely the Ryan White HIV care model, results in effective HCV care delivery. Creation of a HCV care cascade helped to identify barriers to care, programmatic strengths, challenges and opportunities for improvement as the HCV program expands within the HIV Program and satellite clinics statewide.