Implementing a Comprehensive Hepatitis C Virus (HCV) Clinic Within a Human Immunodeficiency Virus Clinic: A Model of Care for HCV Microelimination

Abstract

Abstract Background Among the 1.2 million people with human immunodeficiency virus (HIV) in the United States, 25% are coinfected with hepatitis C virus (HCV). The availability of effective direct acting antivirals (DAAs) makes the goal of HCV elimination feasible, but implementation requires improvements to the HCV treatment cascade, especially linkage to and initiation of treatment in underserved populations. Methods In this retrospective review, a cohort of patients receiving care at a hospital-based HIV clinic in New Haven, Connecticut (January 1, 2014–March 31, 2017) with chronic HCV infection not previously treated with DAAs were followed longitudinally. Patients were referred to a colocated multidisciplinary team. Standardized referral and treatment algorithms and electronic medical record templates were developed, monthly meetings were held, and a registry was created to review progress. Results Of 173 patients, 140 (80.9%) were 50–70 years old, 115 (66.5%) were male, 99 (57.2%) were African American, 43 (24.9%) were white, and 23 (13.3%) were Hispanic. Comorbidities included the following: cirrhosis (25.4%), kidney disease (17.3%), mental health issues (60.7%), alcohol abuse (30.6%), and active drug use (54.3%). Overall, 161 (93.1%) were referred, 147 (85%) were linked, 122 (70.5%) were prescribed DAAs, and 97 (56.1%) had sustained viral response at 12 weeks posttreatment or cure (SVR12). Comparison between those with SVR12 and those unsuccessfully referred, linked, or treated, showed that among those not engaged in HCV care, there was a higher proportion of younger (mean age 54.2 vs 57 years old, P = .022), female patients (P = .001) and a higher frequency of missed appointments. Conclusions Establishing a colocated HCV clinic within an HIV clinic resulted in treatment initiation in 70.5% of patients and SVR12 in 56.1%. This success in a hard-to-treat population is a model for achieving microelimination goals set by the World Health Organization.