2015 APHA Annual Meeting & Expo

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Online Program

333836
Building a Clinical Model for Improved Linkage and Navigation within the HCV Care Cascade


Monday, November 2, 2015

Alexander Geboy, Medical Clinical Research Center, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC
Hyun Cha, LGSW, Medical Clinical Research Center, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC
Idene Perez, Medical Clinical Research Center, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC
Matthew Bell, Medical Clinical Research Center, MedStar Health Research Institute @ MedStar Washington Hospital Center, Washington, DC
Adebisi Ayodele, Nurse Practitioner, Department of Medicine, MedStar Washington Hospital Center, Washington, DC
Dawn Fishbein, MD, Department of Medicine, MedStar Washington Hospital Center, Washington, DC
BACKGROUND: The HCV testing and treatment paradigm is rapidly shifting. Identifying gaps along the HCV care cascade will reduce health disparities and HCV-induced morbidity and mortality. A dynamic, multidisciplinary HCV care model is needed to ensure eradication.

METHODOLOGY: In January 2014, a Gilead FOCUS Initiative funded HepC Linkage to Care Navigation program at MedStar Washington Hospital Center (MWHC) was established to engage existing MWHC HCV patients not in care (over one year) and create a reproducible care model. Goals: 95% of patients identified are linked, 85% retained for 60 days, 80% at 90 days and 75% at 180 days post initiation . A descriptive analysis is presented.

RESULTS:  At December 30, 2014, 250 eligible patients were identified, 192 (77%) were linked to care.  Of those, 167 (87%) were seen at appointment; mean age was 58.4 + 8.7 years; 93% were black, 57% were men, 81% had public insurance, 51% reported prior IVDU. Rates reflect 160 (96%) retained through 60d, 147 (88%) through 90d, and 107 (64%) through 180d.  Of those seen, 143 (86%) underwent liver staging, 151 (90%) HCC screenings were ordered, 105 (69%) completed; 34 (20%) prescriptions were written, 22 (13%) treated, 4 (2%) achieved SVR12.

CONCLUSION: This program successfully navigated, retained, and staged HCV persons previously out of care. Gaps still appear, and providers must initiate linkage, especially for those lost to prior treatment failure, toxic side effects, or treatment ineligibility. By utilizing a dynamic approach to care coordination, drop-offs can be mitigated, care integrated and treatment initiated. Further comparison models are necessary.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Discuss navigation and linkage models for enhanced engagement along the HCV care cascade

Keyword(s): Chronic Disease Management and Care, Hepatitis C

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the program manager and coordinator for federal grants and industry sponsored grants and clinical research trials pertaining to hepatitis C virus treatment and care at MedStar Health Research Institute at MedStar Washington Hospital Center. Additionally, I oversee operations for the HepC Linkage to Care Navigation program that works to engage HCV infected patients into integrated, prompt, patient-centered care within the District of Columbia.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3210.0: Poster session: Health insurance coverage and providers