title: Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model--Arizona and Utah, 2012-2014.
abstract: Hepatitis C virus (HCV) infection is the leading reason for liver transplantation and a common cause of hepatocellular carcinoma, the most rapidly increasing cause of cancer-related deaths in the United States. Of the approximately 3 million persons living with HCV infection in the United States, an estimated 38% are linked to care, 11% are treated, and 6% achieve cure. Recent development of highly effective and well-tolerated medications, such as sofosbuvir and simeprevir, to treat chronic HCV infection shows promise in curbing rising HCV-related morbidity and mortality, with the potential to cure >90% of patients. To fully benefit from these new treatments, improvement in linkage to care and treatment is urgently needed.* Lack of provider expertise in HCV treatment and limited access to specialists are well-documented barriers to HCV treatment. In September 2012, CDC funded programs in Utah and Arizona to improve access to primary care providers with the capacity to manage and treat HCV infection. Both programs were modeled on the Extension for Community Healthcare Outcomes (Project ECHO), developed by the University of New Mexico's Health Sciences Center in 2003 to build primary care capacity to treat diseases among rural, underserved populations through videoconferencing and case-based learning in "teleECHO" clinics. To assess the effectiveness of these programs in improving primary care provider capacity and increasing the number of patients initiating treatment, process and patient outcome data for each state program were analyzed. In both states, Project ECHO was successfully implemented, training 66 primary care clinicians, predominantly from rural settings. Nearly all (93%) of the clinicians had no prior experience in care and treatment of HCV infection. In both states combined, 129 (46%) of HCV-infected patients seen in teleECHO clinics received antiviral treatment, more than doubling the proportion of patients expected to receive treatment. These findings demonstrate Project ECHO's ability to expand primary care capacity to treat HCV infection, notably among underserved populations.
authors.forename: Kiren
authors.initials: K
authors.lastname: Mitruka
authors.forename: Karla
authors.initials: K
authors.lastname: Thornton
authors.forename: Susanne
authors.initials: S
authors.lastname: Cusick
authors.forename: Christina
authors.initials: C
authors.lastname: Orme
authors.forename: Ann
authors.initials: A
authors.lastname: Moore
authors.forename: Richard A
authors.initials: RA
authors.lastname: Manch
authors.forename: Terry
authors.initials: T
authors.lastname: Box
authors.forename: Christie
authors.initials: C
authors.lastname: Carroll
authors.forename: Deborah
authors.initials: D
authors.lastname: Holtzman
authors.forename: John W
authors.initials: JW
authors.lastname: Ward
mesh_terms: D001130:Arizona; D019317:Evidence-Based Medicine; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D017146:Models, Organizational; D011320:Primary Health Care / Q000458:organization & administration*; D014589:Utah