By Megan Brooks
NEW YORK (Reuters Health) - Even with help, safety-net primary care clinics serving low-income and uninsured populations in the U.S. often fall short in screening baby boomers for hepatitis C virus (HCV), as recommended by the U.S. Preventive Services Task Force, according to a new study.
The study evaluated the Screen, Treat, Or Prevent Hepatocellular Carcinoma (STOP HCC) program, conducted in six safety-net primary care practices serving mostly Hispanic communities with high burdens of cirrhosis and liver cancer. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model informed implementation of the multicomponent STOP HCC program.
"We supported the practices to (help them) operationalize national guidelines to . . . test all adults born from 1945 through 1965 (baby boomers) for HCV infection and to treat those with chronic HCV," said coauthor Dr. Barbara Turner of the Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of USC in California.
Despite the offers of support, these practices "varied widely in conducting HCV screening and treatment. Most still had substantial logistical and financial barriers to performing screening and managing infection - even though they serve communities that are disproportionately affected by liver disease," Dr. Turner said by email.
As reported online today in Annals of Internal Medicine, screening baby boomers for HCV in participating practices was "virtually nonexistent" prior to STOP HCC but increased to 48% of 27,700 eligible baby boomers over a period of 29 to 43 months. However, screening rates varied by practice from about 20% to 71% of eligible patients.
In four participating federally qualified health centers, 174 (85%) of 205 uninsured baby boomers diagnosed with chronic HCV completed disease staging but only 74 (36%) completed HCV treatment, ranging from 28% to 60% by practice. Of the treatment-completers, 70 (95%) patients achieved a cure.
Dr. Turner told Reuters Health, "If, in the United States, policymakers and the health system want to prioritize curing millions of Americans with chronic HCV in order to eradicate this serious threat to health, we must recognize that uninsured patients need to have these tests paid for and practices need to have additional financial support to be able to manage patients diagnosed with chronic HCV. Furthermore, even patients who are on Medicaid have many barriers to accessing effective HCV treatment. Moreover, these primary care practices surveying vulnerable populations must find the resources and time to manage HCV in the context of managing multiple acute and chronic diseases and delivering preventive care."
Dr. Turner concludes, "Until these specific initiatives are underway, diagnosing and curing chronic HCV infection requires external funds - such as from grants or public health projects - that support the patient's and the practices to address this very common infection."
Funding for the study was provided by Cancer Prevention & Research Institute of Texas and the Centers for Medicare & Medicaid Services.
Ann Intern Med 2019.