Background: Recent advances in Hepatitis C Virus (HCV) treatment will have limited impact without improvements in screening, detection, and linkage to care. We developed an integrated HCV Specialty Clinic, led by an Infectious Disease physician and an Internist, within a resident primary care clinic. We describe our experiences from the first year of this program and have developed a cascade of care model to evaluate our progress.
Methods: The HCV clinic is situated within an urban, resident-led primary care clinic. Patients enrolled in the primary care clinic from July 1st 2015 through June 30th 2016 (the first year of the integrated clinic) were included in our study population. Patients with a positive HCV viral load were classified as having chronic HCV infection. Demographic data were used to estimate the number of chronic HCV infections among those not tested. Chart reviews of all patients with chronic HCV were performed to create a cascade of care model.
Results: There were 2,955 active patients during the study period. The estimated chronic HCV prevalence was 6.4% (n=190; 95% CI: 5.6 - 7.4%). There were 113 patients with confirmed chronic HCV and 77 estimated undiagnosed cases. Of the 113 patients with chronic HCV, 91 were referred to care, 73 attended one HCV clinic appointment, 39 were started on therapy, 30 completed therapy, and 24 achieved sustained virologic response (SVR) [Figure 1]. Of these 113 patients, 43 had been referred prior to the study period; of the remaining 70 patients, 44 (63%) were referred during the study period. Half of these patients (n=22) attended an integrated clinic appointment and 10 (45.5%) were initiated on HCV treatment during the study period.
Conclusion: We report a high prevalence of chronic HCV within our clinic population, highlighting the need for continued efforts to improve diagnosis and treatment of chronic HCV. Our cascade of care model shows that we perform well on the latter parts of the treatment cascade, while identifying opportunities for improvement with regard to screening for HCV. To our knowledge, this is the first report of a cascade of care model being applied to an integrated HCV clinic in a primary care setting.
Figure 1: Cascade of Care for Hepatitis C Virus Infection Within an Integrated Hepatitis C Virus Clinic