Implementing clinic-based hepatitis C care cascades for persons with HIV/HCV coinfection in Ryan White HIV/AIDS program clinics and health department jurisdictions: A multi-site pilot study of data to care methods
Maximilian Wegener, Ralph Brooks, Lisa Nichols, Merceditas VillanuevaBackground
Improving the HCV care cascade for persons with HIV coinfection requires local engagement of front-line clinics and health departments (HD). The Data to Care (D2C) approach involves ongoing communication between HDs and individual clinics, leveraging surveillance and clinical data to promote successful care outcomes.
Objectives
To show that it is feasible to create clinic-based HCV care cascades by using the Case Conferencing Data Tool created for Ryan White HIV/AIDS Program (RWHAP) clinics and HD jurisdictions.
Design
A prospective, 12-month longitudinal study evaluating the implementation of a clinic-based HCV clearance cascade tool across 14 diverse clinical sites.
Methods
We adapted a D2C approach by developing a spreadsheet-based Case Conferencing Data Tool enabling clinics to develop HCV care cascades with HD input to track patient progress, implement HCV treatment interventions, and enlist HD assistance as needed. We trained 14 Ryan White-HIV/AIDS Program (RWHAP) clinics and 7 HD jurisdictions to use the tool to longitudinally track the HCV status of a cohort of coinfected patients (active in care as of 11/30/2021) for one year.
Results
There were 1543 patients: 76% were male, 46% White, 43% Hispanic, 32% aged 56-65 years old. The baseline HCV care status showed that 956 (62%) were treatment eligible, of which 613 (64%) initiated treatment, 569 (62%) completed treatment, and 503 (53%) had documented SVR (sustained virologic response). After 1 year (11/30/2022), cumulatively, an additional 46 persons achieved SVR and 27 completed PCR testing in the clinics.
Conclusion
Case conferencing methodology differed among sites, but most had coordination between the HDs and clinics. Use of the tool enabled clinics to formalize HCV treatment quality improvement efforts, which, through HD collaboration, promoted accountability and provided access to additional resources.