Journal Article

Effectiveness of a Decentralized Hub and Spoke Model for the Treatment of Hepatitis C Virus in a Federally Qualified Health Center

Khasira, Maureen, Northrup, Adam, Frenette, Catherine, Godino, Job G., Ramers, Christian B., Tam, Aaron, Rojas, Sarah A., Asmus, Lisa

2021

Overview

Hepatitis C virus (HCV) is a major cause of cirrhosis, liver cancer, and mortality in the United States. We assessed the effectiveness of decentralized HCV treatment delivered by nurse practitioners (NPs), primary care physicians (PMDs), or an infectious disease physician (ID MD) using direct‐acting antivirals in a Federally Qualified Health Center (FQHC) in urban San Diego, CA. We conducted a cross‐sectional analysis of 1,261 patients who received treatment from six NPs, 10 PMDs, and one ID MD practicing in 10 clinics between January 2014 and January 2020. Care was delivered based on the Extension for Community Healthcare Outcomes (Project ECHO) model with one hub and nine spokes. HCV was deemed cured if a patient had a sustained virologic response (SVR) after 12 weeks of treatment (SVR12). We evaluated differences in the prevalence of cure between provider types and hub or spoke status using Poisson regression. Patients were 34% Latino, 16% black, 63% were aged >50 years, and 59% were homeless; 53% had advanced fibrosis, 69% had genotype 1, and 5% were coinfected with human immunodeficiency virus. A total of 943 patients achieved SVR12 (96% per protocol and 73% intention to treat). Even after adjustment for demographics, resources, and disease characteristics, the prevalence of cure did not differ between the ID MD and PMDs (prevalence ratio [PR], 1.00; 95% confidence interval [CI], 0.95‐1.04) or NPs (PR, 1.01; 95% CI, 0.96‐1.05). Similarly, there were no differences between the hub and spokes (PR, 1.01; 95% CI, 0.98‐1.04). Conclusion: Among a low‐income and majority homeless cohort of patients at urban FQHC clinics, HCV treatment administered by nonspecialist providers was not inferior to that provided by a specialist.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins,John Wiley and Sons Inc,Wolters Kluwer Health/LWW
• Subject: Antiviral Agents - therapeutic use / Antiviral drugs / Baby boomers / California / Clinics / Cohort Studies / Collaboration / Community Health Centers - economics / Community Health Centers - organization & administration / Cross-Sectional Studies / Electronic health records / Financing, Government / Hepacivirus / Hepatitis C / Hepatitis C - drug therapy / Hepatitis C - ethnology / HIV / Human immunodeficiency virus / Humans / Ill-Housed Persons - statistics & numerical data / Immune system / Infections / Infectious diseases / Intention to Treat Analysis / Liver / Liver cancer / Liver cirrhosis / Models, Organizational / Original / Patient Acceptance of Health Care - ethnology / Patient Acceptance of Health Care - statistics & numerical data / Patients / Poisson Distribution / Practice Patterns, Physicians' - statistics & numerical data / Primary care / Sustained Virologic Response / Urban Population - statistics & numerical data / Variables