title: Provider Workforce Assessment in a Rural Hepatitis C Epidemic: Implications for Scale-up of Antiviral Therapy.
abstract: New recommendations for birth cohort screening for hepatitis C virus (HCV) infection and the development of new, highly effective antiviral medications are expected to increase the demand for HCV treatment. In the past, antiviral therapy for HCV was almost exclusively prescribed by specialists in the field of gastroenterology and infectious diseases, meaning that people living in rural areas that are underserved by specialists may have poor access to treatment. We investigated the number and geographic distribution of medical providers who actively prescribed direct acting antiviral drugs for hepatitis C in Wisconsin during 2012. Using public health surveillance data and a state-wide prescription drug database, we found that there was 1 treatment provider for every 340 residents known to be living with HCV. However, 51 of 72 Wisconsin counties had no providers who provided HCV treatment in 2012.Scaling up antiviral treatment to address the epidemic of hepatitis C efficiently and equitably will require strategies to increase the number of treatment providers in rural communities. Providing education, training, and support to the primary care workforce serving rural communities should be considered a potentially effective and efficient approach to preventing future HCV-related illness.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI, USA rpw@medicine.wisc.edu.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Westergaard
authors.affiliation: Wisconsin Division of Public Health, Madison, WI, USA.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Stockman
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Hyland
authors.affiliation: Wisconsin Division of Public Health, Madison, WI, USA.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Guilfoyle
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Fangman
authors.affiliation: Wisconsin Division of Public Health, Madison, WI, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Vergeront
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D009842:Oligopeptides / Q000008:administration & dosage; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011392:Proline / Q000008:administration & dosage / Q000031:analogs & derivatives; D012423:Rural Health; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D009842:Oligopeptides; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D011392:Proline
keywords: access to care; efficiency; medications; primary care; rural health