Years Of Program Implementation Research Articles

1086. Antimicrobial Stewardship: From Bedside to Man’s Best Friend

BackgroundAntimicrobial stewardship plays an integral role in ensuring appropriate antimicrobial use in the inpatient hospital setting and is now required by The Joint Commission. Although it is well established that antimicrobial misuse and overuse has societal and ecological implications, the same regulations do not yet apply to our veterinary and agricultural counterparts.MethodsAt The Ohio State University Wexner Medical Center (OSUWMC), the Antimicrobial Stewardship Program (ASP) was created in 2007. A partnership was formed with The Ohio State University Veterinary Medical Center (OSUVMC) in 2017 and was leveraged through a pre-existing campus-wide One Health initiative. The goal was to develop a comprehensive Veterinary Hospital ASP. “The Core Elements of Hospital Antibiotic Stewardship Programs” (Centers for Disease Control and Prevention) and “The Core Principles of Antibiotic Stewardship in Veterinary Medicine” (American Veterinary Medical Association) were also referenced for guidance.ResultsSpecific initiatives within the OSUVMC ASP were modeled after similar interventions in the OSUWMC including development of antibiotic use guidelines by animal type for commonly encountered infections, antimicrobial utilization tracking, antibiogram creation, and both active and passive surveillance of targeted resistant pathogens. A mobile-friendly website was created to allow providers easy access to these ASP tools. Overall antimicrobial prescriptions decreased 22.4% following the first year of program implementation. Planning is currently underway for an ASP outreach program to local veterinary practices to increase awareness of ASP and improve antimicrobial prescribing. A parallel outreach program with rural Ohio hospitals is underway at OSUWMC.ConclusionA comprehensive veterinary hospital ASP was successfully implemented in collaboration with OSUWMC counterparts using successful human interventions applied in the animal setting. Optimizing antimicrobial use and resistance at both sites will likely prevent resistance transmission between these geographically proximate hospitals. Sharing the details of our approach may benefit other institutions looking to expand their stewardship reach.Disclosures All authors: No reported disclosures.

Implementation of an Opioid Guideline Impacts on Opioid Prescriptions, Adverse Outcomes, and an Association with a State Opioid-Related Fatalities.

The aim of this study was to determine the efficacy of an evidence-based opioid guidelines-based program implemented at the largest worker's compensation insurer in Utah. All new claims, including surgeries, were included. Pre- and post-intervention comparisons included percentage of claims treated with an opioid, provision of a second opioid prescription, opioid use above 50 mg morphine equivalent dose (MED), opioid use more than 90 mg MED, and opioid use over 90 days. There were significant (P < 0.001) reductions in all primary outcomes, with a reduction in MEDs in the 18 months after implementation totaling 65,502 mg. This program significantly reduced the usage of opioids among acute claims. The year of program implementation, Utah experienced a 19.8% reduction in opioid-related fatalities, which may be partly related to the reduction in MEDs. Regardless, this study suggests that the implementation of an evidence-based guideline is impactful and feasible.

GOOD BEHAVIOR GAME – AN ALTERNATIVE TO TRADITIONAL CLASS MANAGEMENT METHODS

The Good Behavior Game (GBG) is a universal prevention program. Its effectiveness in diminishing risky behaviors has been confirmed in several studies. GBG targets children starting their school education with the objective to create a positive school environment for all students and to improve their social functioning. In this article we would like to present: 1) GBG as a classroom behavior management method implemented in several countries across years; 2) the project of GBG adaptation to Polish schools and: 3) experiences of Polish GBG coaches after the first year of program implementation. GBG is based on behavioral theories and the life course/social field theory. It centers on four key elements: class rules, team membership, positive reinforcement (praises, rewards, celebrations) and monitoring of children’s behaviors and GBG data. In Poland, the program is piloted in Warsaw and Kraków. In the article, evaluation data collected in individual interviews with GBG coaches are presented and discussed.

Two-Year Changes in Neighborhood Juvenile Arrests After Implementation of a Park-Based Afterschool Mental Health Promotion Program in Miami-Dade County, Florida, 2015-2017.

Objectives. To examine the association of Fit2Lead, an afterschool park-based youth mental health promotion program, and neighborhood juvenile arrests (2015-2017) in Miami-Dade County, Florida. Methods. We tracked juvenile (ages 12-17 years) arrest rates over 2 years of program implementation across zip codes matched by (1) park and (2) baseline sociodemographics and youth arrests. Fit2Lead mental and physical health, meditation, resilience, and life skills activities were offered in 12 high-need areas for youths (n = 501) aged 12 to 17 years. We tested the association of Fit2Lead implementation (binary variable) and change in juvenile arrest rates by zip code, adjusting for area-level gender, age, race/ethnicity, single-parent households, and poverty. Results. Fit2Lead was offered in areas composed of 48% male youths, 60% Hispanics, 29% non-Hispanic Blacks, 33% single-parent households, and 33% of residents living in poverty. After covariate adjustment, zip codes with Fit2Lead implementation showed a significant mean reduction (P < .001) in youth arrests per 10 000 youths aged 12 to 17 years per year compared with zip codes without program implementation (b = -6.9; 95% confidence interval = -9.21, -4.65). Conclusions. Park-based programs may have the potential to promote mental health and resilience, and also to prevent violence among at-risk youths.

Gender Differences in HIV/HSV-2: Evidence from a School Support Randomized Controlled Trial Among Orphaned Adolescents in Kenya.

Women and girls are disproportionately affected by HIV and other sexually transmitted infections(STIs) such as Herpes Simplex Virus type-2 (HSV-2) in Sub-Saharan Africa (SSA). Given this gender disparity and women's vulnerability to HIV/STIs, prevention efforts often target women, but relatively little attention has been paid to compare whether HIV interventions produce equal program effects across gender. The purpose of this study is to examine whether the school support intervention had equal program effects on study outcomes and biomarkers by gender among orphaned adolescents in Kenya. A randomized controlled trial was conducted to test whether keeping orphaned boys and girls in school reduced risky sexual behaviors and prevented HIV/HSV-2 infection in Kenya (N = 835). We collected four annual surveys and biomarkers measures of HIV and HSV-2 at Time 1 and Time 4. Regression analysis and multi-level linear mixed models were conducted, and t test with Satterthwaites' method for each regression coefficients was used to compare program effects by gender. There were substantial gender differences on risky sexual behaviors, HSV-2 infection, and gendered ideologies prior to intervention implementation. The school support intervention had significant gender-specific program impacts on HSV-2. The intervention females experienced a 36% increase in HSV-2 infection while intervention males experienced a 23% decrease after 3years of program implementation. Differential program effects by gender on attitudes toward abstaining from sex were also found. More scientific research is needed to test whether HIV interventions produce equal program impacts by gender. Prevention programs should recognize gender-specific program effects and address individual, relational, and contextural factor that reinforce the gender disparity in HIV/HSV-2 risk.

Introducing KiVa school-based antibullying programme to the UK: A preliminary examination of effectiveness and programme cost

Bullying is an internationally recognized problem and school-based bullying is particularly pervasive. KiVa is a robustly evidenced school-based antibullying programme developed and evaluated at Turku University, Finland, and subsequently disseminated across Finland. Following a positive UK trial of Unit 2 (for 10- to 12-year-olds), further UK dissemination has taken place. This study presents (a) pupil self-reported levels of victimization and bullying prior to, and after, one year of KiVa implementation (Units 1 and 2) with 7- to 11-year-olds from 41 schools, and (b) programme training and delivery costs. Data from 41 primary schools were analysed using a linear mixed model effects analysis. Results revealed statistically significant reductions in victimization and bullying after one year of programme implementation. Ongoing costs were small, at £2.84 per Key Stage 2 pupil per annum. These promising results highlight the need for further more rigorous evaluation of KiVa in the UK, including the exploration of factors associated with effective implementation, and the importance for educators and policy makers of evaluating both impact and costs when implementing programmes to prevent and reduce bullying.

College Guidance for All: A Randomized Experiment in Pre‐College Advising

AbstractPre‐college advising programs exist in most disadvantaged high schools throughout the United States. These programs supplement traditional advising by high school guidance counselors and attempt to help underrepresented and disadvantaged students overcome the complexities of the postsecondary admission and financial aid processes. Existing evidence on these programs often uses within‐school randomization where spillovers and alternative supports may confound estimates. We provide the first evidence on a whole school intervention resulting from a school‐level randomized controlled trial in the United States. The college access program we study uses a near‐peer model where a recent college graduate works at the school assisting students in the application and enrollment process. Pooled results across the first three years of program implementation find no significant impacts on overall college enrollment. However, subgroup analyses reveal positive, significant effects among the groups most targeted by the intervention: Hispanic and low‐income students. Most of the impact comes through increasing two‐year college enrollment, but this appears to be new entrants rather than inducing students to move from four‐year to two‐year colleges. The observed positive effects for these subgroups attenuate over time. We attribute this drop in the estimated impact to departures in fidelity of the experiment. Even among the cohorts for which we find positive enrollment impacts, we find no significant impacts on college persistence.

Assessing and monitoring the impact of the national newborn hearing screening program in Israel

BackgroundThe Israeli Newborn Hearing Screening Program (NHSP) began operating nationally in January 2010. The program includes the Otoacoustic Emissions (OAE) test for all newborns and Automated Auditory Brainstem Response (A-ABR) test for failed OAE and infants at risk for auditory neuropathy spectrum disorders. NHSP targets are diagnosis of hearing impairment by age three months and initiation of habilitation by six months.Objectives(1) Review NHSP coverage; (2) Assess NHSP impact on age at diagnosis for hearing impairment and age at initiation of habilitation; (3) Identify contributing factors and barriers to NHSP success.Methods(1) Analysis of screening coverage and referral rates for the NHSP; (2) Analysis of demographic data, results of coverage, age at diagnosis and initiation of habilitation for hearing impaired infants pre-implementation and post-implementation of NHSP from 10 habilitation centers; (3) Telephone interviews with parents whose infants failed the screening and were referred for further testing.ResultsThe NHSP coverage was 98.7% (95.1 to 100%) for approximately 179,000 live births per year for 2014–2016 and average referral rates were under 3%. After three years of program implementation, median age at diagnosis was 3.7 months compared to 9.5 months prior to NHSP. The median age at initiation of habilitation after three years of NHSP was 9.4 months compared to 19.0 prior to NHSP. Parents (84% of 483 sampled) with infants aged 4–6 months participated in the telephone survey. While 84% of parents reported receiving a verbal explanation of the screening results, more than half of the parents reported not receiving written material. Parental report of understanding the test results and a heightened level of concern over the failed screen were associated with timely follow-up.ConclusionsThe findings indicate high screening coverage. The program reduced ages at diagnosis and initiation of habilitation for hearing impaired infants. Further steps needed to streamline the NHSP are improving communication among caregivers to parents to reduce anxiety; increasing efficiency in transferring information between service providers using advanced technology while ensuring continuum of care; reducing wait time for follow-up testing in order to meet program objectives. Establishment of a routine monitoring system is underway.

Rural household income distribution and inequality in China: Effects of payments for ecosystem services policies and other factors

In the late 1990s, China initiated the Conversion of Croplands to Forest Program (CCFP) and the Ecological Welfare Forest Program (EWFP) based on the Payments for Ecosystem Services (PES) principle. Positive socioeconomic outcomes of the programs are essential for the long-term success of eco-environment conservation. However, there is lack of understanding of their longer-term (over 10 years) impacts on rural livelihoods. In this paper, we examine income distribution and inequality of rural households under CCFP and EWFP in rural Anhui, China after 12 years of program implementation. Results show that CCFP-participating households have higher income inequality than non-participants, while the EWFP does not have a significant effect. Local off-farm work and out-migration with remittances are the two principal income sources and both add to inequality. A regression-based decomposition of inequality shows that the CCFP indirectly alters livelihoods by increasing out-migration with remittances, but it also adds to inequality from shifting livelihoods to non-agricultural activities. Meanwhile, EWFP payments positively affect agricultural incomes and contribute 16% to agricultural income inequality. Finally, human capital, natural capital and physical capital all play important roles in generating income and inequality, but the factors affecting inequality from agricultural and non-agricultural activities are different.

Patient Satisfaction of BPJS Kesehatan Service after Three Years of Program Implementation

BPJS Kesehatan has had a large coverage in short period of time. The rapid expansion of health insurance coverage has created demand which cannot be met by current healthcare system and will disrupt the delivery service1. The disruption of service, as a consequence, will influence the satisfaction. Patient satisfaction evaluation is important because it is not only as an important indicator to evaluate the achievement of the program but also it is important to improve treatment outcome. At present there is limited report on patients’ satisfaction to BPJS Kesehatan provider. This study is aiming to find out the satisfaction level of BPJS Kesehatan in Indonesia after 3 years of program implementation.

Patient Satisfaction of BPJS Kesehatan Service after Three Years of Program Implementation

Patient Satisfaction of BPJS Kesehatan Service after Three Years of Program Implementation

A Vaccine Against Cervical Cancer: Context for the Global Public Health Practitioner.

Gavi, the Vaccine Alliance provides support for vaccine introduction and immunization programs in eligible countries; country eligibility for support from Gavi is chiefly determined by the gross national income (GNI) per capita, which determines the level of co-financing and nature of vaccine program support available.14 Between 2012 and 2016, both Gavi and vaccine manufacturers funded sub-national demonstration projects in countries around the world to better understand how to feasibly and sustainably deliver HPV vaccine to adolescents, a relatively new target age group that does not routinely access health services, especially in low- and middle-income countries. Gavi-eligible countries needed to demonstrate successful vaccination to this new target age group prior to requesting funds for national HPV vaccine introduction. Starting in 2017, Gavi shifted its focus from demonstration programs to national introductions, aiming to scale up early lessons learned and to accelerate progress toward the goal of protecting 40 million girls from cervical cancer by 2020 in Gavi-eligible countries.15 Following WHO recommendations, Gavi enacted policy to support vaccination of multiple age cohorts in the first year of program implementation for Gavi-eligible countries. However, due to current global vaccine shortage, some countries have been advised to target a single age group for the first year of introduction, with the potential to vaccinate multiple age cohorts in the future, as supply allows. Demonstrating experience in delivering the vaccine to adolescents is no longer a prerequisite for support of national implementation in these countries. Following WHO's change in HPV vaccine policy and Gavi's shift in program support, many Gavi-eligible countries are moving rapidly to introduce HPV vaccine into their national immunization programs.

Can a conditional cash transfer reduce teen fertility? The case of Brazil’s Bolsa Familia

In 2008, Brazil's conditional cash transfer program expanded to cover a wider range of ages. Poor families are now given stipends for their children's school attendance up to age seventeen, whereas prior the maximum age was fifteen. Using a nationally representative household survey, we estimate the impact of this policy on teen fertility with a triple difference analysis on the fertility outcomes of treated cohorts vs. non-treated cohorts based on income eligibility, age eligibility, and timing of program implementation. We find a three percentage point drop in fertility among eligible teens within five years of program implementation. This offsets the difference in fertility between poor and non-poor teens. The impact is concentrated in urban areas, with no program effects found in rural areas. We are able to replicate these findings using National Birth Registry Data.

The Phased Implementation of a National Telehealth Weight Management Program for Veterans: Mixed-Methods Program Evaluation.

BackgroundThe burden of obesity is high among US veterans, yet many face barriers to engaging in in-person, facility-based treatment programs. To improve access to weight-management services, the Veterans Health Administration (VHA) developed TeleMOVE, a home-based, 82-day curriculum that utilizes in-home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility-based services.ObjectiveThe primary aim was to establish preliminary evidence for the program by comparing outcomes for TeleMOVE with standard, facility-based MOVE weight-management services (group, individual modalities) over the evaluation period based on the number of patients enrolled per site and the program’s clinical effectiveness, as demonstrated by average weight lost per patient. The secondary aim was to understand factors influencing TeleMOVE implementation variability across demonstration sites to develop recommendations to improve national program dissemination.MethodsWe employed a formative mixed-methods design to evaluate the phased implementation of TeleMOVE at 9 demonstration sites and compare patient- and site-level measures of program uptake. Data were collected between October 1, 2009 and September 30, 2011. Patient-level program outcomes were extracted from VHA patient care databases to evaluate program enrollment rates and clinical outcomes. To assess preliminary clinical effectiveness, weight loss outcomes for veterans who enrolled in TeleMOVE were compared with outcomes for veterans enrolled in standard MOVE! at each demonstration site, as well as with national averages during the first 2 years of program implementation. For the secondary aim, we invited program stakeholders to participate in 2 rounds of semistructured interviews about aspects of TeleMOVE implementation processes, site-level contextual factors, and program delivery. Twenty-eight stakeholders participated in audio-recorded interviews.ResultsAlthough stakeholders at 3 sites declined to be interviewed, objective program uptake was high at 2 sites, delayed-high at 2 sites, and low at 5 sites. At 6 months post enrollment, the mean weight loss was comparable for TeleMOVE (n=417) and MOVE! (n=1543) participants at −5.2 lb (SD 14.4) and −5.1 lb (SD 12.2), respectively (P=.91). All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE! due to logistical and technical assistance issues related to the devices. High-uptake sites overcame implementation challenges by leveraging communication networks with stakeholders, adapting the program to patient needs whenever possible, setting programmatic goals and monitoring feedback of results, and taking time to reflect and evaluate on delivery to foster incremental delivery improvements, whereas low-uptake sites reported less leadership support and effective communication among stakeholders.ConclusionsThis implementation evaluation of a clinical telehealth program demonstrated the value of partnership-based research in which researchers not only provided operational leaders with feedback regarding the effectiveness of a new program but also relevant feedback into contextual factors related to program implementation to enable adaptations for national deployment efforts.

367 Emergency Department Warm Handoff Program: Using Peers to Improve Emergency Department Patient Engagement and Linkages to Community-Based Substance Use Disorder Services

1) To improve emergency department (ED) patient engagement and linkages to substance-use disorder (SUD) services in the community by strengthening existing workflows 2) To move from pilot to program by integrating Certified Recovery Peer Advocates (CRPA) into ED workflow and culture 3) To reduce avoidable ED visits by moving SUD care from the ED into community settings In the initial 6 months of the pilot phase, Certified Addiction Recovery Coaches (CARC) and Certified Recovery Peer Advocates (CRPA) were introduced and integrated in the ED as hospital staff to engage, educate, and advocate for patients and support clinicians in making connections to appropriate SUD services. Using Motivational Interviewing skills and lived experience, peers supported the enhanced workflow by engaging and connecting patients with substance use needs, who typically decline services, to the appropriate level of care. ED clinicians activated peers through in-person requests and by placing orders for peer services through the electronic health record (EHR), which ensured that patients met with the peer before discharge. In addition, peers participated in routine medical rounds to case find and engage individuals coming to the ED with falls, car crashes, and other injuries to determine if SUD was the underlying cause for their ED visit. After a successful pilot period, the implementation team scaled up the intervention to become a program of the hospital ED. The implementation team convened hospital leadership and the hospital’s outpatient SUD clinic to develop a sustainability plan. This plan included guidance on reimbursement for CRPA services, enhanced CRPA responsibilities in the ED at the outpatient clinic, revised ED workflows, and guidelines for continued engagement with the SUD population. Peers, which were previously employed through an outside agency, were hired as hospital staff and re-introduced into the ED with expanded roles and responsibilities to ensure patient engagement and linkages remained person centered and patient driven. In 1 year of program implementation (November 2016 to November 2017, including the pilot phase), there have been 1,049 patient engagements of which 659 were unique patients. 16% of those engagements resulted from case finds. Over 130 handoffs (12.4% of engagements) were made to SUD providers, which is a significantly higher (p-value < 0.0001) than the Substance Abuse and Mental Health Services (SAMHSA) reported national average of people who accepted treatment (1.5%). There was a 27% reduction in avoidable ED visits for people with SUD and other behavioral health diagnoses from November 2016 to August 2017. 3 full-time peers were integrated as hospital employees (2 assigned to the ED, 1 in the outpatient clinic). To move towards integration, peers were granted access to the EHR to support clinicians in coordinating linkages between the ED and the hospital’s outpatient clinic as well as additional community based programs. The WHP was an innovative approach to transform ED workflow and reduce avoidable ED visits using peers. As demonstrated by positive outcomes in patient engagement, linkages to community-based care and ED visits, peers are an essential component to providing patient-driven care for the SUD population. Cross-training peers in best practices for mental health, substance use, HIV, and social determinants of health is an area for further investigation.

The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria

This paper analyzes the quantitative impact of an intervention that provides subsidized low-cost private health insurance together with health facility upgrades in Nigeria. The evaluation, which measures impact on healthcare utilization and spending, is based on a quasi-experimental design and utilizes three population-based household surveys over a 4-year period. After 4 years, the intervention increased healthcare use by 25.2 percentage points in the treatment area overall and by 17.7 percentage points among the insured. Utilization of modern healthcare facilities increased after 4 years by 20.4 percentage points in the treatment area and by 18.4 percentage points among the insured due to the intervention. After 2 years of program implementation, the intervention reduced healthcare spending by 51% compared with baseline, while after 4 years, spending resumed to pre-intervention levels.

Is it Good to Have Options? The 2014 Farm Bill Program Decisions

AbstractThe 2014 Farm Bill continued the trend towards more risk management‐based support for U.S. farmers. However, it also represents a major departure from previous legislation by introducing multiple program options among which producers had the ability to choose. While allowing producers to have choices creates flexibility, the design of the program required producers to consider potential outcomes for crop prices and production levels in future periods when making their decisions. Experience over the first two years of program implementation suggests that while programs are working as designed, not all producers are fully satisfied with their enrollment decisions. This will lead to proposals for further modification to programs, and to questions about whether program choice should be a component of the next Farm Bill.

Response to Comment on Ely et al. A National Effort to Prevent Type 2 Diabetes: Participant-Level Evaluation of CDC’s National Diabetes Prevention Program. Diabetes Care 2017;40:1331–1341

In response to Ritchie et al. (1) regarding the first report from the Centers for Disease Control and Prevention (CDC) of findings from the National Diabetes Prevention Program (National DPP) (2), we respectfully submit the following. Our article (2) is an initial, preliminary report of data from the first few years of program implementation and data collection only. It describes the experience of 14,747 adults enrolled in year-long type 2 diabetes prevention programs from February 2012 through January 2016. As of July 2017, the National DPP had …

Protocol and baseline data for a multi-year cohort study of the effects of different mass drug treatment approaches on functional morbidities from schistosomiasis in four African countries

BackgroundThe Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) focus is on randomized trials of different approaches to mass drug administration (MDA) in endemic countries in Africa. Because their studies provided an opportunity to evaluate the effects of mass treatment on Schistosoma-associated morbidity, nested cohort studies were developed within SCORE’s intervention trials to monitor changes in a suite of schistosomiasis disease outcomes. This paper describes the process SCORE used to select markers for prospective monitoring and the baseline prevalence of these morbidities in four parallel cohort studies.MethodsIn July 2009, SCORE hosted a discussion of the potential impact of MDA on morbidities due to Schistosoma infection that might be measured in the context of multi-year control. Candidate markers were reviewed and selected for study implementation. Baseline data were then collected from cohorts of children in four country studies: two in high endemic S. mansoni sites (Kenya and Tanzania), and two in high endemic S. haematobium sites (Niger and Mozambique), these cohorts to be followed prospectively over 5 years.ResultsAt baseline, 62% of children in the S. mansoni sites had detectable eggs in their stool, and 10% had heavy infections (≥ 400 eggs/g feces). Heavy S. mansoni infections were found to be associated with increased baseline risk of anemia, although children with moderate or heavy intensity infections had lower risk of physical wasting. Prevalence of egg-positive infection in the combined S. haematobium cohorts was 27%, with 5% of individuals having heavy infection (≥50 eggs/10 mL urine). At baseline, light intensity S. haematobium infection was associated with anemia and with lower scores in the social domain of health-related quality-of-life (HRQoL) assessed by Pediatric Quality of Life Inventory.ConclusionsOur consensus on practical markers of Schistosoma-associated morbidity indicated that height, weight, hemoglobin, exercise tolerance, HRQoL, and ultrasound abnormalities could be used as reference points for gauging treatment impact. Data collected over five years of program implementation will provide guidance for future evaluation of morbidity control in areas endemic for schistosomiasis.Trial registrationThese cohort studies are registered and performed in conjunction with the International Standard Randomised Controlled Trial Registry trials ISRCTN16755535, ISRCTN14117624, ISRCTN95819193, and ISRCTN32045736.

Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island

IntroductionThe availability of curative hepatitis C therapies has created an opportunity to improve treatment delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. Material and methodsUsing a community-based prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: 1) treatment effectiveness using intention-to-treat analysis; and 2) patient treatment experience assessed using demographics, adverse events, and medication adherence. ResultsDuring the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses. ConclusionIn conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.