A program run by University researchers aims to quickly identify and provide comprehensive treatment for medically underserved patients who are chronically infected with the hepatitis C virus, according to a new study published in the Feb. 14 issue of the Journal of General Internal Medicine.
Hepatitis C — a blood-borne disease that inflames the liver — is an “underfunded, understudied and seriously large health problem,” said Amy Nunn, assistant professor of behavioral and social sciences and medicine, who co-authored the study.
“Its magnitude is not to be underestimated and there are at least five to seven times as many people living with hepatitis C than its more infamous counterpart, HIV,” Nunn said. Unlike for hepatitis A and B, there is no vaccination available for hepatitis C.
The study, which was conducted in several medically underserved Philadelphia neighborhoods, was “to my knowledge the largest nonclinical hepatitis C screening that has ever been undertaken,” Nunn said.
The researchers’ program, called “Do One Thing,” has been in the works since early 2012 and includes large-scale outreach, a door-to-door awareness campaign, mobile units and aggressive linkage-to-care services, said Stacey Trooskin, assistant professor in the division of infectious diseases and HIV medicine at Drexel University College of Medicine and a co-author of the study.
The program also included new features for hepatitis C screening. Many of the current screening procedures only include an antibody reactive test, but 15 to 25 percent of patients who test positive for antibodies have already cleared the virus on their own and are no longer chronically infected, Trooskin said. That system allows for false positive results for hepatitis C, she added.
But “Do One Thing” was one of the first community-based hepatitis C testing programs to apply a model of confirmatory testing, Trooskin said. The confirmatory test allows for a same-day blood draw with results available within 48 hours of testing, Nunn said.
Nunn said the accelerated screening process for diagnosis was just the first step toward treatment. Patients must be linked to care, retained through the treatment process and ultimately cured, she said.
One of the biggest hurdles to overcome was ensuring that patients received their entire treatment regimen, Nunn said.
Many patients had other “competing demands in their lives,” including other health issues and problems with substance abuse. “Most people fall out of care right after they get the results of their rapid test,” she added.
It is important to be adaptive to the “multidimensional components of someone who might have hepatitis C,” said Brianna Norton, primary care specialist at Montefiore Medical Center, who was not involved in the study. For example, there is a potential link between hepatitis C, HIV and syphilis, she added.
Nunn said the program assigned volunteer patient navigators to deliver the confirmatory test results and to “hold (the patients’) hands and make sure they did not fall out of care.”
Other obstacles included helping patients find health insurance and acquiring a referral from a primary care provider. The treatment process for hepatitis C is systematically challenging and “this need for a referral was a true barrier,” Trooskin said. “The patient navigation piece was key to helping patients overcome that issue,” she added.
Though effective medications with few side effects exist, they “are astronomically expensive and getting insurance approval is extremely arduous,” Norton said.
Barriers to treatment persist at the level of the system itself, not the patient, said Lynn Taylor, assistant professor of medicine and director of the Miriam Hospital’s HIV/Viral Hepatitis Coinfection Program, who was not involved with the study.
“Right now we need to take a giant machete and hack through the red tape and the bureaucracy and the politics and stop preventing people from gaining access to the lifesaving medications,” she said.
Nunn said the program worked within the confines of a constrained system. “Though it has been overwhelmingly challenging, with patient navigators, talented physicians and army of students, we were able to overcome all those barriers,” she said.
The next step involves expanding the program into more communities, Trooskin said.
“I want to cure everyone and replicate this model, and I want to expand training efforts to clinical settings here in Rhode Island,” Nunn said.
