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. 2018 Jan-Dec:9:2150132718807520.
doi: 10.1177/2150132718807520.

A Regional Analysis of Hepatitis C Virus Collaborative Care With Pharmacists in Indian Health Service Facilities

Rebecca Geiger  1 , Jessica Steinert  2 , Grant McElwee  3 , Jennifer Carver  4 , Robert Montanez  5 , Julie Niewoehner  6 , Cassandra Clark  7 , Brigg Reilley  8
Affiliations

A Regional Analysis of Hepatitis C Virus Collaborative Care With Pharmacists in Indian Health Service Facilities

Rebecca Geiger et al. J Prim Care Community Health. 2018 Jan-Dec.

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] J Prim Care Community Health. 2019 Jan-Dec;10:2150132718824513. doi: 10.1177/2150132718824513. J Prim Care Community Health. 2019. PMID: 30600753 Free PMC article. No abstract available.

Abstract

Background: American Indian/Alaska Natives (AI/ANs) are disproportionately affected by hepatitis C virus (HCV), with more than double the national rate of HCV-related mortality as well as the highest rates of acute HCV. The "cascade of care" for HCV consists of screening, confirmation, treatment, and sustained virologic clearance (SVR)/cure. At each stage of this process, patients can be lost to follow-up. Federal health care facilities in an administrative area of the Indian Health Service conducted a review to identify and address gaps in HCV treatment. Facilities generally treated HCV with a strong pharmacy component using a collaborative practice agreement and HCV telehealth services to external specialists.

Methods: All facilities had a pharmacist HCV program point of contact. Each pharmacist conducted a chart review of HCV patients and submitted aggregate results on HCV antibody status, HCV confirmation testing, stage of liver disease, initiation of treatment, and SVR/cure. Each facility also ranked current barriers to scaling up HCV treatment services from a defined list of options.

Results: Of 1789 HCV antibody positive patients, 77% (1381) had a confirmation test, of which 67% (929) were positive. Of these patients, 62% (576) had their liver fibrosis scored, and 58% (335) had initiated treatment. Of patients with an SVR/cure test, all (274/274) were negative.

Discussion: These data indicate that rural clinics can be successful providing HCV diagnosis and treatment. Pharmacists can play a key role in HCV clinical services. The outcomes of each step in the treatment process at the facility level can vary widely due to local factors. The barriers to HCV care that persist are nonclinical.

Keywords: American Indian/Alaska Native; access to care; hepatitis C virus; rural.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Hepatitis C virus (HCV) patient diagnoses and treatment (cumulative), Oklahoma Administrative Area federal health facilities, Indian Health Service, December 2017.
See this image and copyright information in PMC

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