[Viva] Fwd: Programming Connection spotlights evidence briefs

Mon Feb 4 08:59:35 PST 2019

Back atcha Charlene 😘 happy Monday all

On Mon, Feb 4, 2019, 8:56 AM Charlene Anderson <pickles4 at shaw.ca wrote:

> Good morning Shelly. Thanks for posting all the info you do. Have a great
> day.
> Char
>
> Sent from my iPhone
>
> On Feb 4, 2019, at 8:24 AM, shelly tognazzini <shetognazzini at gmail.com>
> wrote:
>
> Interesting study stats on Hep C. Good morning😊
>
> ---------- Forwarded message ---------
> From: CATIE <mailer at catie.ca>
> Date: Mon, Feb 4, 2019, 8:21 AM
> Subject: Programming Connection spotlights evidence briefs
> To: <shetognazzini at gmail.com>
>
>
> Check HepC
>
> Shared experience. Stronger programs.
> View this email in your browser
> <https://mailchi.mp/b2d5b7a634b3/programming-connection-spotlights-evidence-briefs?e=3006f90030>
> [image: CATIE Programming Connection]
>
> *Evidence Brief*
>
> Evidence briefs review a single study on a specific HIV or hepatitis C
> prevention, testing, treatment, care or support program. Evidence briefs
> provide a summary of up-to-date and peer-reviewed literature that includes
> both Canadian and international programming.
> *Check Hep C*
> New York City, USA
> 2018
>
> Check Hep C is a community-based program in New York City focused on
> linkage to care and patient navigation for hepatitis C treatment for
> high-risk populations, including people who use drugs. This program is
> based out of community health centres (CHCs) and needle and syringe
> programs (NSPs). Patient navigators support individuals through the
> testing, diagnosis and treatment process. This program successfully linked
> 85% of people diagnosed with a current hepatitis C infection to care in
> year one. Thirty percent of program participants who were diagnosed with
> hepatitis C infection were cured in year two of the program.
>
> *Program description1,2 *
>
> The Check Hep C program was rolled out at CHCs and harm reduction programs
> located in low-income neighbourhoods with high rates of hepatitis C,
> serving predominantly minority populations. The CHCs provided onsite
> hepatitis C care and treatment, harm reduction programs and social
> services. The core program component was a patient navigator at each site
> who helped support patients through hepatitis C treatment and care.
> Navigators assessed patient needs for physical and mental health, substance
> use and social support.
>
> Individuals were recruited to the program via outreach at the
> participating CHCs and NSPs and in the community. Upon entering the
> program, patients received a point-of-care antibody test. The point-of-care
> test produced screening results within the same appointment. If the test
> result was positive, blood was drawn during the same appointment for the
> confirmatory RNA test. Confirmatory RNA test results were typically
> available within seven days.
>
> If patients were diagnosed with chronic hepatitis C infection, they were
> referred to a patient navigator located at the CHC or NSP. Participants at
> CHCs had access to onsite clinical care, whereas patients evaluated at NSPs
> were connected to external clinical care. A care plan for each participant
> was created on the basis of their assessment. Patient navigators were
> trained to provide comprehensive linkage-to-care services, including:
>
>    - creating and following a care plan for each patient
>    - making medical appointments for clients and accompanying them if
>    needed
>    - case management to address barriers to care
>    - counselling for treatment readiness and adherence
>    - health education and linkage to other services
>    - enrollment into benefits programs and assistance with insurance
>
> *Results*
>
> A study1 (2012 to 2013) on year one of the program looked at the Check
> Hep C program’s ability to perform screening and confirmatory tests, link
> people to care and initiate treatment (only interferon-based treatment was
> available at the time of this study). The study was conducted at 12 sites
> including CHCs and NSPs. A patient was considered linked to care if they
> attended a minimum of one hepatitis C medical appointment after diagnosis.
>
>    - A total of 4,751 individuals were tested for hepatitis C infection,
>    with 512 (11%) having a confirmed, current infection.
>    - Of those with a current infection, 435 (85%) individuals attended at
>    least one hepatitis C medical appointment.
>
> The study followed patients who were linked to care onsite at a CHC. Of
> the 157 patients linked to care in year one:
>
>    - 30% were considered treatment candidates
>    - 9% initiated treatment
>    - 4% were cured (43% of those who started treatment were cured)
>
> A separate study on year two of the program from 2014 to 20152 followed
> participants after they had already been diagnosed with a chronic hepatitis
> C infection. This study was conducted in two CHCs and two NSPs that had
> participated in year one of the program. Sixty-one percent of participants
> were born between 1945 and 1965, 73% were male (26% female and 1%
> transgender), 49% reported being dependent on non-injection drugs in the
> past year, including opioid substitution therapy, and 28% reported having a
> mental health condition. Of the 388 participants enrolled in the program:
>
>    - 77% completed a hepatitis C medical evaluation (linked to care)
>    - 61% were eligible for treatment (using direct-acting antivirals
>    [DAAs])
>    - 33% started treatment
>    - 30% were cured (91% of those who started treatment were cured)
>
> This 30% cure rate represents a two-fold increase over the estimated 12%
> to 15% cure rate overall in New York City.3
>
> Participants evaluated onsite at CHCs were significantly more likely to be
> eligible for treatment (86%) than participants who were referred for
> offsite services (76%) and were more than twice as likely to initiate
> treatment (46%) than offsite participants (25%). No significant differences
> were reported in cure rates between the two groups.
>
> *Some participants more likely to start treatment than others*
>
> In the 2012 to 2013 study,1 many participants were not considered to be
> candidates for treatment because they had other conflicting health
> conditions, they did not have liver fibrosis, they had ongoing alcohol or
> drug use issues or they were lost to follow-up. This resulted in low
> overall treatment numbers. At the time of this study, only interferon-based
> treatment was available. The authors suggest that many providers were
> waiting for new, more effective DAA treatments to become available before
> prescribing treatment.
>
> By 2014 to 2015, DAA treatments had become available, although strict
> guidelines set by health insurers prevented many patients from accessing
> the drugs. Reasons for ineligibility included active drug use, conflicting
> health conditions and current alcohol use. Participants with more severe
> fibrosis (F3 or F4 fibrosis score) were twice as likely to begin treatment
> as those with less severe fibrosis (F1 or F2), and those born between 1945
> and 1965 were twice as likely to start treatment as all other age groups.
> Participants who were homeless, used injection drugs, used alcohol or had a
> chemical dependence were less likely to start treatment than those who were
> housed and/or who didn’t use substances.
>
> *What does this mean for service providers?*
>
> People who use drugs continue to experience significant barriers to
> treatment such as lack of access to healthcare, and stigma and
> discrimination associated with substance use. Linkage to care is even more
> essential because new DAA treatments are highly effective and easy to
> complete and they can be accessed with few restrictions in Canada. This
> study shows that high hepatitis C cure rates can be achieved in populations
> that have not been traditionally well-served by the healthcare system when
> health navigation is part of their care plan.
>
> Patient navigators played a central role in this program in helping
> clients navigate the HCV continuum of care
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=68b88e7748&e=3006f90030>,
> including testing, diagnosis and treatment. There is typically significant
> patient drop-off at each stage and using a patient navigator helped to
> mitigate this.
>
> The Check Hep C program model also demonstrates the effectiveness of
> point-of-care testing followed by immediate blood draws for confirmatory
> testing. Because this testing can all be done in one appointment (followed
> by a seven-day wait for RNA results), a hepatitis C diagnosis can be made
> in a shorter time, reducing the risk of losing a patient to follow-up.
>
> *Related resources*
>
> Hepatitis C point of care testing: What is its impact on testing and
> linkage to care?
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=42f18d92e2&e=3006f90030>
> HepTLC
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=d294a8c9cb&e=3006f90030>–
> evidence brief
> Patient Navigation
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=dd34a55b58&e=3006f90030>
> – evidence brief
> Ontario Hepatitis C Team: The Ottawa Hospital and Regional Hepatitis
> Program
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=47fbd1dc68&e=3006f90030>
> – case study
> Practice Guidelines in Peer Health Navigation for People Living with HIV
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=859688a623&e=3006f90030>
>
> *References*
>
>    1. Ford MM, Jordan AE, Johnson N et al. Check Hep C: a community-based
>    approach to hepatitis C diagnosis and linkage to care in high-risk
>    populations. *Journal of Public Health Management and Practice. *
>    2018:24(1):41–8.
>    2. Ford M, Johnson N, Desai P et al. From care to cure: demonstrating
>    a model of clinical patient navigation for hepatitis C care and treatment
>    among high-need patients. *Clinical Infectious Diseases*.
>    2017:64(5):685–91.
>    3. Balter S, Stark JH, Kennedy J et al. Estimating the prevalence of
>    hepatitis C infection in New York City using surveillance data. *Epidemiology
>    and Infection*. 2014 Feb;142(2):262–9.
>
>
> For more evidence briefs on linkage to care programming, see the Programming
> Connection
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=c78b3406d0&e=3006f90030>
> .
>
> The Programming Connection is an online collection of innovative HIV and
> hepatitis C program models.  If you have any feedback or know of a
> successful program in your region, please contact us at:
> programmingconnection at catie.ca.
> *eduCATIE.ca
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> CATIE offers open online courses through eduCATIE.ca to build knowledge
> of HIV and hepatitis C science. Courses are self-directed and are designed
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> own pace. All participants receive a certificate of completion. Read more.
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