Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era.

Falade Nwulia O,Sulkowski Ms,Mehta Sh,Mcadams Mahmoud A,Irvin R,Thomas Dl,Mix M,Page Kr,Niculescu A

doi:10.4172/2161-0711.1000481

Falade Nwulia O, Sulkowski Ms + Show 7 more

Open Access

https://doi.org/10.4172/2161-0711.1000481

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Abstract

BackgroundThere are over 3 million Americans infected with hepatitis C virus (HCV). Despite recent advances in HCV treatment, a major barrier to care remains a limited number of treaters. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians.ObjectiveTo characterize current HCV care practices, willingness and self-efficacy of PCPs to become HCV treaters.Design, participants and main measuresTwo hundred and seventy one PCPs were identified from community clinics affiliated with a large academic center and 4 large federally qualified health centers in Baltimore, MD. An internet-based survey was administered to assess provider demographics, clinical practice site and willingness to provide HCV care. Factors associated with willingness to provide HCV care were examined using odds ratios (OR).Key resultsAmong 129 (48%) PCPs who responded, the majority (70%) had an MD/DO degree and were white (60%). Only a few PCPs, 12 (10%), had treated at least 1 patient for HCV in the prior year. Although only 22% agreed that HCV treatment should be provided by PCPs, 84% were interested in more HCV training. Willingness to provide treatment was strongly linked to having a high proportion of HCV-infected patients (>20% versus <20%; OR 3.9; 95% confidence interval [CI] 1.5–10) and availability of other services at the primary care site including HIV treatment (OR 6.5; 95% CI 2.5–16.5), substance abuse treatment (OR 3.3; 95% CI 1.3–8.4) and mental health services (OR 4.9; 95% CI 2.0–12.1).ConclusionThese data suggest that efforts to expand HCV medical provider capacity will be most impactful if they initially focus HCV training on PCPs with a high prevalence of HCV among their patients and existing systems to support HCV care.

Highlights

There are over 3.2 million Americans infected with the hepatitis C virus (HCV) [1]
The primary care sites of these primary care providers (PCPs) were largely non-academic community based primary care sites (84%) with an equal proportion located in urban (48%) and nonurban (51%) locations; 21% of PCPs worked at sites where greater than 20% of their patients were HCV infected
A majority (64%) of PCPs agreed that HCV treatment was important in the communities they served while 48% believed that developing capacity to treat hepatitis C would benefit their clinic

Summary

Introduction

There are over 3.2 million Americans infected with the hepatitis C virus (HCV) [1]. HCV infection is associated with liver cirrhosis, liver cancer and death and since 2007 has accounted for more deaths in the US than HIV [2]. Because over 75% of HCV infections are in individuals born between 1945 and 1965, the Centers for Disease Control and Prevention (CDC) and the United States Preventative Services Task Force (USPSTF) have recommended that individuals born in these years (“the birth cohort”) be tested at least once for HCV, independent of any identified risk factors [4,5]. These recommendations alleviate the discomfort reported by clinicians in eliciting HCV risk factors and may increase HCV testing and case detection rates [6]. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians

Results

Discussion

Conclusion