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Open access case consultations with HCV experts in [rural] Michigan for Opioid Users
AN OPEN ACCESS HEPATITIS C VIRUS CASE CONSULTING PROGRAM TO EXPAND FRONTLINE COMMUNITY PROVIDER CAPACITY
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AASLD 2021 Nov 12-15
Ponni V. Perumalswami1, Robert McMorrow2, Kaylyn Curtis2, Erin Wright3, Audrey Hazelbaker4, Mary F Myrick5, Maureen Mead6, Lynsie Stepanski6, Dan Oliver6, Miranda Jackson5, Andrea Daoust6, Timothy Shewcraft4, Allison Lin7, Amy Bohnert7, Brandon Harkonen4, Sheba Sethi4 and Anna S. Lok8, (1)Gastroenterology Section, Ann Arbor VA Healthcare System, (2)Addiction Medicine, Midmichigan Community Health, (3)Great Lakes Recovery Centers, Inc., (4)University of Michigan, (5)OSF Healthcare St Francis Hospital & Medical Group, (6)Alcona Health Center, (7)Psychiatry, University of Michigan, (8)Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States
Background: Until April 2021, Michigan Medicaid required frontline healthcare providers to consult with hepatitis C virus (HCV) specialists to prescribe direct acting antiviral therapy. The Michigan Opioid Collaborative is focused on expanding access to medications for opioid use disorder (OUD) by building frontline healthcare provider capacity across the state. Rural counties in Michigan, where access to HCV specialists is limited, have a disproportionate burden of patients living with OUD and related infectious diseases including HCV. We aimed to build HCV capacity among frontline providers through open access case consultations with experts.
Methods: From October 2020 to April 2021, two hepatologists offered open access HCV case consultation. HCV cases without personal health information were submitted by frontline providers via email using a template to a hepatologist who responded with recommendations within 48 hours. HCV cases were also discussed as part of a biweekly case conference open to any frontline provider (not required) interested to learn HCV.
Results: Ten unique frontline providers from 5 sites all located in rural counties across Michigan participated by submitting 46 cases in the first 6 months of the program. The median age for HCV cases was 36 ± 8 years and 46% were female patients. All HCV cases were in people living with OUD with 87% receiving buprenorphine treatment. All patients were HCV treatment naïve and the most common genotypes were 1a (62%) and 3 (20%). At least two noninvasive fibrosis assessments were performed on each patient with a mean FIB-4 1.01 ± 0.47 and one patient was identified with advanced fibrosis and referred to a specialist. A total of 34 (74%) patient have started DAA treatment (50% glecaprevir/pibrentasvir, 50% sofosbuvir/velpatasvir) with 6 currently on treatment, 24 completed treatment pending confirmation of sustained virological response 12, and 4 cured. One patient was lost to follow up after completing 6 weeks of treatment and 11 were not prescribed treatment as they were lost to follow up.
Conclusion: Open access case consultations with HCV experts can support frontline health care providers to learn and expand HCV capacity, particularly in rural counties, with high rates of treatment initiation and completion. Since April 2021 Michigan is one of 7 states that has eliminated HCV prescribing restrictions including the need for a specialist and sobriety and many other states may benefit from a similar model.
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