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Hepatitis C virus infection (HCV) is a significant cause of liver cancer infecting millions of individuals unaware of the presence of the disease. HCV shows a higher prevalence in those with less education and individuals of a lower socio-economic status, presenting a challenge for affordable screening, diagnosis and care.
Traditionally, persons who are well-insured have the greatest access to hepatitis treatment; however alternate models for care are necessary to meet the needs of Chatham County populations with HCV disparities, especially the uninsured. For example, the increased numbers of newly diagnosed baby boomers alone will eventually outpace the capacity of specialists to treat these patients. Programs that increase primary care providers’ capacity to screen, link, and treat HCV infection are crucial. One such program has been implemented at St. Joseph’s/Candler in the system’s two safety net clinics, St. Mary’s Health Center and the Good Samaritan Clinic through the Nancy N and J.C. Lewis Cancer & Research Pavilion’s (LCRP) cancer prevention program.
The LCRP is a Community Cancer Center in Coastal Georgia. LCRP disparities efforts focus on cancer prevention, screening, and facilitating access to cancer care for two nurse-managed clinics for uninsured, low-income, predominately African American and Hispanic populations. In 2014, the LCRP began implementing Centers for Disease Control (CDC) HCV testing guidelines as a cancer prevention strategy at these clinics.
As HCV patients at St. Joseph’s/Candler safety net clinics were identified, it became clear that disease specific protocols needed to be developed. The development of these protocols focused on overcoming obstacles and barriers including a general lack of CDC clinical testing guidelines resulting in inaccurate diagnosis, secondary prevention and treatment resulting in non-evidence-based clinical care, the perception that expensive HCV treatment is inaccessible for uninsured patients, and finally the statewide under-utilization of Electronic Medical Record (EMR) and other data tracking tools.
The LCRP worked with the clinics to address these obstacles and identified community and statewide educational resources, physician champions, and technical assistance along with providing program implementation, and data monitoring support. A multi-disciplinary team developed secondary prevention protocols while a clinical team implemented testing and treatment algorithms resulting in a 60% increase in testing and diagnosis. Secondary prevention activities are focused on to prevent further liver damage including vaccination, and referrals for alcohol and/or substance abuse counseling.
In 2014, no HCV+ individuals had been treated at St. Joseph’s/Candler two safety net clinics. In 2015, three HCV+ individuals were treated using medication provided through MedBank, a pharmaceutical assistance program, and using a nurse-practitioner co-management treatment model supported by an internal medicine physician specializing in HCV treatment. The use of EMRs allowed improved patient tracking and evidence-based care. LCRP hopes the results of this program will provide a model for traditionally difficult to access preventive care and treatment for high risk populations.
For more information, please contact Sarah Dobra, Disparities Program Manager, at the Nancy N. and J.C. Lewis Cancer & Research Pavilion at 912-819-8636 or DOBRAS@sjchs.org. For more information on LCRP cancer programs visit, cancerpavilion.com.