TY - JOUR
T1 - Hepatitis C virus screening and care
T2 - Complexity of implementation in primary care practices serving disadvantaged populations
AU - Turner, Barbara J.
AU - Rochat, Andrea
AU - Lill, Sarah
AU - Bobadilla, Raudel
AU - Hernandez, Ludivina
AU - Choi, Aro
AU - Guerrero, Juan A.
N1 - Funding Information:
STOP HCC was supported by the Cancer Prevention & Research Institute of Texas and a quality improvement project funded within a Medicaid Section 1115 transformation waiver to the Texas Health and Human Services Commission. These funding agencies has no role in study design, conduct, or reporting.
Funding Information:
EMR and protocols established to continue screening program Tapering grant funds for research team and onsite staff support Stable staffing and commitment to maintain HCV screening and management with limited funding Partnership to identify and access external funding sources to maintain program components for uninsured patients anti-HCV = hepatitis C virus antibody; BPA = best practice alert; DAA = direct-acting antiviral; EMR = electronic medical record; HCV = hepatitis C virus; LVN = licensed vocational nurse; RE-AIM = Reach, Effectiveness, Adoption, Implementation, and Maintenance; REDCap = Research Electronic Data Capture database; STOP HCC = Screen, Treat, Or Prevent Hepatocellular Carcinoma; SVR = sustained virologic response. * Adapted from Forman and colleagues (19). † Used by 4 clinics for treatment of uninsured patients.
Funding Information:
Financial Support: By grant PP150079 from the Cancer Prevention & Research Institute of Texas and by Section 1115 Medicaid waiver 085144601.2.1 from the Centers for Medicare & Medicaid Services Disclosures: Dr. Turner reports salary support from the American College of Physicians and University of Texas Health Science Center at San Antonio, as well as grants from the Cancer Prevention & Research Institute of Texas and project support through the Centers for Medicare & Medicaid Services Section 1115 Medicaid waiver program during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org /authors/icmje/ConflictOfInterestForms.do?msNum=M18-3573.
Funding Information:
Financial Support: By grant PP150079 from the Cancer Prevention & Research Institute of Texas and by Section 1115 Medicaid waiver 085144601.2.1 from the Centers for Medicare & Medicaid Services
PY - 2019/12/17
Y1 - 2019/12/17
N2 - Background: Hepatitis C virus (HCV) disproportionately affects disadvantaged communities. Objective: To examine processes and outcomes of Screen, Treat, Or Prevent Hepatocellular Carcinoma (STOP HCC), a multicomponent intervention for HCV screening and care in safety-net primary care practices. Design: Mixed-methods retrospective analysis. Setting: 5 federally qualified health centers (FQHCs) and 1 family medicine residency program serving low-income communities in diverse locations with largely Hispanic populations. Patients: Persons born in 1945 through 1965 (baby boomers) who had never been tested for HCV and were followed through May 2018. Intervention: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model guided implementation and evaluation. Test costs were covered for uninsured patients. Measurements: All practices tested patients for anti-HCV antibody (anti-HCV) and HCV RNA. For uninsured patients with chronic HCV in 4 practices, quantitative data also enabled assessment of HCV staging, specialist teleconsultation, direct-acting antiviral (DAA) treatment, and sustained virologic response (SVR). Implementation fidelity and adaptation were assessed qualitatively. Results: Anti-HCV screening was done in 13 334 of 27 700 baby boomers (48.1%, varying by practice from 19.8% to 71.3%). Of 695 anti-HCV–positive patients, HCV RNA was tested in 520 (74.8%; 48.9% to 92.9% by practice), and 349 persons (2.6% of those screened) were diagnosed with chronic HCV. In 4 FQHCs, 174 (84.9%) of 205 uninsured patients with chronic HCV had disease staging, 145 (70.7%) had teleconsultation review, 119 (58.0%) were recommended to start DAA therapy, 82 (40.0%) initiated free DAA therapy, 74 (36.1%) completed therapy (27.8% to 60.0% by practice), and 70 (94.6% of DAA completers) achieved SVR. Implementation was promoted by multilevel practice engagement, patient navigation, and anti-HCV screening with reflex HCV RNA testing. Limitation: No control practices were included, and data were missing for some variables. Conclusion: Despite a similar framework for STOP HCC implementation, performance varied widely across safety-net practices, which may reflect practice engagement as well as infrastructure or cost challenges beyond practice control.
AB - Background: Hepatitis C virus (HCV) disproportionately affects disadvantaged communities. Objective: To examine processes and outcomes of Screen, Treat, Or Prevent Hepatocellular Carcinoma (STOP HCC), a multicomponent intervention for HCV screening and care in safety-net primary care practices. Design: Mixed-methods retrospective analysis. Setting: 5 federally qualified health centers (FQHCs) and 1 family medicine residency program serving low-income communities in diverse locations with largely Hispanic populations. Patients: Persons born in 1945 through 1965 (baby boomers) who had never been tested for HCV and were followed through May 2018. Intervention: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model guided implementation and evaluation. Test costs were covered for uninsured patients. Measurements: All practices tested patients for anti-HCV antibody (anti-HCV) and HCV RNA. For uninsured patients with chronic HCV in 4 practices, quantitative data also enabled assessment of HCV staging, specialist teleconsultation, direct-acting antiviral (DAA) treatment, and sustained virologic response (SVR). Implementation fidelity and adaptation were assessed qualitatively. Results: Anti-HCV screening was done in 13 334 of 27 700 baby boomers (48.1%, varying by practice from 19.8% to 71.3%). Of 695 anti-HCV–positive patients, HCV RNA was tested in 520 (74.8%; 48.9% to 92.9% by practice), and 349 persons (2.6% of those screened) were diagnosed with chronic HCV. In 4 FQHCs, 174 (84.9%) of 205 uninsured patients with chronic HCV had disease staging, 145 (70.7%) had teleconsultation review, 119 (58.0%) were recommended to start DAA therapy, 82 (40.0%) initiated free DAA therapy, 74 (36.1%) completed therapy (27.8% to 60.0% by practice), and 70 (94.6% of DAA completers) achieved SVR. Implementation was promoted by multilevel practice engagement, patient navigation, and anti-HCV screening with reflex HCV RNA testing. Limitation: No control practices were included, and data were missing for some variables. Conclusion: Despite a similar framework for STOP HCC implementation, performance varied widely across safety-net practices, which may reflect practice engagement as well as infrastructure or cost challenges beyond practice control.
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U2 - 10.7326/M18-3573
DO - 10.7326/M18-3573
M3 - Article
C2 - 31791065
AN - SCOPUS:85077365591
VL - 171
SP - 865
EP - 874
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 12
ER -