Watch the video & take notes on a sheet of paper
Once you have registered on Medscape, reach the page http://www.medscape.com/viewarticle/879380
When you have finished, click on each item below to see the answer.
Testing, Care, and Cure of Hepatitis C Can Be Done in Primary Care – Medscape – May 05, 2017.
- ≅ 2.7-3.9 million persons in US chronically infected with HCV
- Persons born 1945 - 1965 estimated to have a prevalence of 3.25%, ≅ 75% of all HCV infections in ← historically high incidence of HCV infection before discovery of virus in 1989
- Twice as high in males as in females, highest prevalence within the birth cohort (8.12%) found among non-Hispanic black males
- From 2010 to 2014 there was a 2.6-fold increase in number of reported cases of acute HCV infection, primarily among young persons who inject drugs
- Significant advances
- Era of all-oral, well-tolerated, highly efficacious direct-acting antiviral medications
- Opportunities for improving testing, care, and cure of HCV in US
- Care cascade from HCV diagnosis to cure:
• Person tested for HCV with an HCV antibody test
• If test positive → diagnosis must be confirmed with HCV RNA test
• If HCV RNA positive → genotype checked & assessment of the severity of liver disease
• Implementation of HCV treatment plan appropriate to the person's specific needs
• Sustained virologic response or cure determined by testing for presence of HCV RNA 12 weeks after completion of treatment
- 50% of those with chronic HCV infection have not been tested for HCV & unaware of infection
- Testing guidelines available from US Preventive Services Task Force, CDC, & American Association for the Study of Liver Diseases & the Infectious Diseases Society of America (AASLD-IDSA)
- Variations in recommendations from the different groups, but all recommend one-time HCV testing for individuals born from 1945 to 1965, regardless of other risks for HCV infection
- All organizations recommend testing persons of any age with the following HCV-related risk factors:
• current or past injection drug use
• receipt of blood transfusions prior to 1992
• receipt of long-term hemodialysis
• children born to HCV-infected mothers
- Interventions to improve HCV antibody & RNA confirmatory testing include
• use of prompts in electronic medical records for identifying eligible patients
• immediate phlebotomy & expedited HCV RNA testing for anti-HCV-positive patients
• use of laboratory services that perform reflex testing on anti-HCV-positive specimens
- Persons not progressing to care and treatment ← they may not follow through with the referral to a specialist who can provide such care
- Interventions such as case management programs and patient navigators shown to be particularly effective for retaining vulnerable patients in care & could be considered if there is concern that patient may be at risk for being lost to follow-up
- In the era of direct-acting antivirals, there are increasing opportunities for primary care providers (PCPs) to provide HCV-directed care & treatment (videoconferencing to train PCPs in the management of HCV-infected persons used to successfully scale up HCV treatment in underserved settings)
- Treatments well tolerated, cure rates > 90% for most patients
- AASLD-IDSA prepared guidance document frequently updated, excellent reference
- Treatment relatively uncomplicated but several third-party payers require preauthorization to obtain approval for HCV treatments → this process can be complicated & variable depending on patient's health plan or payer, & can be burdensome for busy healthcare providers
- →National Viral Hepatitis Roundtable created resources for healthcare providers to help navigate this process, including templates for appealing denials
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Route 66 to medical literature, Félicie Pastore 2017