P0990 - Removing Barriers to Treatment of Chronic Hepatitis C Using a Streamlined Algorithm and Partnership With a Specialty Pharmacy in an Internal Medicine Resident Clinic

Alexander K. Malik, MD¹, Bradley Allen. Moore, MD², Joseph P. Myers, MD², Ganesh Veerappan, MD^3
1Summa Health System, Akron, OH; ²Summa Health, Akron, OH; ³Akron Digestive Disease Consultants, Akron, OH

Introduction: Chronic hepatitis C virus (cHCV) infection is a common cause of chronic liver disease and can progress to cirrhosis and hepatocellular carcinoma. Antiviral therapy (AVT) is the cornerstone of cHCV treatment with newer therapies effectively eradicating HCV RNA and attaining sustained virologic response (SVR). Barriers in underserved communities can hinder patient access to care for cHCV, including lack of primary care provider experience with treating cHCV, resulting in subspecialist referrals, care delays, and logistical challenges like insurance prior authorization and medication costs.

Methods: We conducted a pre-/post-test design to evaluate the confidence of clinicians to identify and initiate AVT for those with cHCV in an underserved patient population. The educational intervention series (EIS) consisted of interactive sessions designed to teach a simplified protocol for obtaining the pre-AVT lab work and assessments of liver fibrosis in patients with cHCV. Clinicians were instructed on coordinating care with a subspecialty pharmacy for insurance prior authorizations and financial assistance for eligible patients. We assessed clinical outcomes by comparing number of cHCV patients and number of patients started on AVT before and after the EIS.



Results: A total of 33 providers participated in the EIS, with 32 completed pre-tests and 31 completed post-tests. The post-test mean score for clinician knowledge of cHCV treatment was 35% higher than the pre-test mean score (Table 1a). Before the EIS, 11/32 (34.4%) clinicians agreed or strongly agreed they had adequate knowledge for treating eligible cHCV patients, while 14/32 (43.8%) clinicians disagreed or strongly disagreed. After the EIS, 30/31 (96.8%) clinicians agreed or strongly agreed that they had adequate knowledge, and none disagreed or strongly disagreed. Before the EIS, 3 of 11 (27%) eligible patients started AVT for HCV, while after the EIS, 3 of 10 (30%) eligible patients started AVT (Table 1b).

Discussion: The EIS improved clinicians' HCV treatment knowledge and confidence, resulting in higher initiation rates of AVT for cHCV. A concise algorithm is needed for managing cHCV in the ambulatory setting to ensure prompt treatment, reduce unnecessary referrals, optimize resources, and prevent loss to follow-up. Further studies are required to confirm the long-term impact of this EIS on achieving SVR in underserved cHCV patients.



Disclosures:


Alexander K. Malik, MD¹, Bradley Allen. Moore, MD², Joseph P. Myers, MD², Ganesh Veerappan, MD³. P0990 - Removing Barriers to Treatment of Chronic Hepatitis C Using a Streamlined Algorithm and Partnership With a Specialty Pharmacy in an Internal Medicine Resident Clinic, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.