Barbara J. Turner, MD, MSEd; Andrea Rochat, MFA; Sarah Lill, MAM; Raudel Bobadilla, BS; Ludivina Hernandez; Aro Choi, MS; Juan A. Guerrero, MD
Acknowledgment: The authors thank Edward Yao for his assistance with data collection and Chen-Pin Wang, PhD, for her assistance with additional data analyses.
Financial Support: By grant PP150079 from the Cancer Prevention & Research Institute of Texas and by Section 1115 Medicaid waiver 085144601.2.1 from the Centers for Medicare & Medicaid Services
Disclosures: Dr. Turner reports salary support from the American College of Physicians and University of Texas Health Science Center at San Antonio, as well as grants from the Cancer Prevention & Research Institute of Texas and project support through the Centers for Medicare & Medicaid Services Section 1115 Medicaid waiver program during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3573.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Not available, but tools and resources can be accessed at www.StopHepatitisC.com; this Web site was developed by the authors to support public and professional education about HCV screening and management. Statistical code: Not available. Data set: Deidentified data set available on request (e-mail, Reachcenter@uthscsa.edu).
Corresponding Author: Barbara J. Turner, MD, MSEd, Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of USC, 2020 Zonal Avenue, IRD 322, Los Angeles, CA 90033; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Turner: Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of USC, 2020 Zonal Avenue, IRD 322, Los Angeles, CA 90033.
Ms. Rochat, Ms. Lill, Mr. Bobadilla, Ms. Hernandez, and Ms. Choi: Center for Research to Advance Community Health (ReACH), UT Health San Antonio, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229.
Dr. Guerrero: University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229.
Author Contributions: Conception and design: B.J. Turner, A. Rochat, S. Lill.
Analysis and interpretation of the data: B.J. Turner, A. Rochat, S. Lill, R. Bobadilla, A. Choi.
Drafting of the article: B.J. Turner, A. Rochat.
Critical revision of the article for important intellectual content: B.J. Turner, A. Rochat, S. Lill, R. Bobadilla.
Final approval of the article: B.J. Turner, A. Rochat, S. Lill, R. Bobadilla, L. Hernandez, A. Choi, J.A. Guerrero.
Provision of study materials or patients: B.J. Turner, R. Bobadilla, L. Hernandez, J.A. Guerrero.
Statistical expertise: B.J. Turner, A. Choi.
Obtaining of funding: B.J. Turner.
Administrative, technical, or logistic support: B.J. Turner, A. Rochat, S. Lill, R. Bobadilla.
Collection and assembly of data: B.J. Turner, R. Bobadilla.
Hepatitis C virus (HCV) disproportionately affects disadvantaged communities.
To examine processes and outcomes of Screen, Treat, Or Prevent Hepatocellular Carcinoma (STOP HCC), a multicomponent intervention for HCV screening and care in safety-net primary care practices.
Mixed-methods retrospective analysis.
5 federally qualified health centers (FQHCs) and 1 family medicine residency program serving low-income communities in diverse locations with largely Hispanic populations.
Persons born in 1945 through 1965 (baby boomers) who had never been tested for HCV and were followed through May 2018.
The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model guided implementation and evaluation. Test costs were covered for uninsured patients.
All practices tested patients for anti-HCV antibody (anti-HCV) and HCV RNA. For uninsured patients with chronic HCV in 4 practices, quantitative data also enabled assessment of HCV staging, specialist teleconsultation, direct-acting antiviral (DAA) treatment, and sustained virologic response (SVR). Implementation fidelity and adaptation were assessed qualitatively.
Anti-HCV screening was done in 13 334 of 27 700 baby boomers (48.1%, varying by practice from 19.8% to 71.3%). Of 695 anti-HCV–positive patients, HCV RNA was tested in 520 (74.8%; 48.9% to 92.9% by practice), and 349 persons (2.6% of those screened) were diagnosed with chronic HCV. In 4 FQHCs, 174 (84.9%) of 205 uninsured patients with chronic HCV had disease staging, 145 (70.7%) had teleconsultation review, 119 (58.0%) were recommended to start DAA therapy, 82 (40.0%) initiated free DAA therapy, 74 (36.1%) completed therapy (27.8% to 60.0% by practice), and 70 (94.6% of DAA completers) achieved SVR. Implementation was promoted by multilevel practice engagement, patient navigation, and anti-HCV screening with reflex HCV RNA testing.
No control practices were included, and data were missing for some variables.
Despite a similar framework for STOP HCC implementation, performance varied widely across safety-net practices, which may reflect practice engagement as well as infrastructure or cost challenges beyond practice control.
Cancer Prevention & Research Institute of Texas and Centers for Medicare & Medicaid Services.
Turner BJ, Rochat A, Lill S, et al. Hepatitis C Virus Screening and Care: Complexity of Implementation in Primary Care Practices Serving Disadvantaged Populations. Ann Intern Med. 2019;171:865–874. [Epub ahead of print 3 December 2019]. doi: https://doi.org/10.7326/M18-3573
Download citation file:
Published: Ann Intern Med. 2019;171(12):865-874.
Published at www.annals.org on 3 December 2019
Gastroenterology/Hepatology, Infectious Disease, Prevention/Screening, Viral Hepatitis.
Results provided by:
Copyright © 2020 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use