HCV Treatment Uptake

This is a chapter of the Enhancing Hepatitis C Testing and Treatment toolkit which provides resources and best practices to help providers to identify and successfully treat hepatitis C infection.

Best Practices

• Identify a staff champion.
• Engage an interdisciplinary team, with specific roles and responsibilities.
• If possible, have a dedicated “HCV Team” including physician, nurse (RN), NP, and MA (all with specific, identified roles/responsibilities)
• Integrate a navigator, peer and/or community health worker (CHW) as part of the HCV team to provide intensive care coordination, and support linkage services for HCV positive individuals who require additional assistance to access and complete HCV treatment. This position can communicate with other agency departments to coordinate care for HCV and other services. Additionally, can provide resources such as bus passes, cab vouchers, food donation centers/drives, etc.
• Accept without judgement and view addiction as an illness and young injectors as people.
• Frame HCV treatment for patients as a way to have control over effects of addiction.
• Reassure patients that they can be treated again should they ever be re-infected, whether they ask about this or not.
• Lower barriers to treatment relative to stages in recovery. “If you feel that now is a good time to commit to taking this treatment and doing a good job sticking to it then I will commit to getting it for you and try to make the process as easy as possible.”
• Work with patients around anxiety/misunderstanding about current HCV treatment.
• Reduce number of blood draws needed before beginning therapy - set up reflex testing for HCV antibody to HCV RNA, and genotype to reduce number of blood draws before starting therapy.
• Maintain a patient registry of all HCV positive patients – build into EMR, if possible.
• Centralize referrals, so one person is outreaching to patients - leverage a patient registry to facilitate this process.
• Establish a formal HCV treatment protocol, including written documentation of your sites HCV treatment workflows.  This can serve as a resource for providers to reference when needed and should be easy to access and share internally.
• Streamline prior authorization (PA) process to one dedicated staff person. For example – RN or CHW handles the PA process. Once the provider submits the medication order, the RN/CHW uses an online system called “covermymeds.com” (CoverMyMeds is an electronic system connected with EHRs that includes provider tools such as prescription decision support, electronic prior authorization (ePA)and specialty support services).  A paper-based system works just as well, particularly when streamlined through one point person). With some cases, the site asks questions that are not applicable to the patient based on insurance plan so the RN/CHW must use a different form, but often a majority of patients have the same insurance, such as BMC or MA Health Standard. The RN/CHW writes the medication the provider chose, answer questions from the insurance company, and attaches appropriate lab work. If approved, the RN/CHW will send the approval to the specialty pharmacy, and if denied, the RN/CHW starts the appeal process.

Resources

• Guidelines for HCV Screening and Treatment in Primary Care - Sections 3-6 (Adapted from Community Health Center of Franklin County)
  The Community Health Center of Franklin County created a tool for clinicians and other staff to support implementation of HCV screening and treatment. Sections 3-6 of the tool address treatment initiation, management, and follow-up. Earlier sections of the tool address screening and follow-up testing.
• HCV Outline for Primary Care Providers (Adapted from SSTAR, Fall River)
  SSTAR of Fall River Massachusetts created a tool for primary care clinicians which provides a succinct overview of treatment for HCV infection, including the tests and actions to evaluate a patient for treatment, manage treatment, and treatment follow-up.  The tool also includes a treatment “checklist” It is available centrally for easy reference.
• Hepatitis C Case Conference Vignette (Source: New England AIDS Education and Training Center and Family Health Center of Worcester)
  YouTube URL: https://youtu.be/aveK8C_IiVo
  Philip Bolduc, MD, Director of the HIV and Viral Hepatitis Fellowship at the Family Health Center of Worcester, and Thanh Thu Ngo, MD, HIV and Hepatitis Fellow, review a hepatitis C case and resources for HCV clinical decision-making. Recorded on 6/10/2021
• Hepatitis C Treatment Patient Orientation (Adapted from SSTAR, Fall River)
  SSTAR of Fall River Massachusetts created a tool for HCV care team members to support patient education. This tool can either serve as a “script” for members of the care team to use in patient education, or it may be used as a patient educational “hand out”.
• Hepatitis C: Getting Cured Is Easier than Ever (Source: National Coordinating Resource Center, AIDS Education and Training Center Program)
  This patient educational resource addresses current HCV treatment in comparison to older treatment regimens to address the reluctance patients sometimes feel regarding hepatitis C treatment initiation based on past experiences with older hepatitis C treatment regimens. This is a downloadable tool available in both English and Spanish. 
• Frequently Asked Questions: Prior Authorization for Hepatitis C Virus (HCV) Treatment (Source: Center for Health Law and Policy Innovation, Harvard Law School)
  This resource addresses questions and concerns gathered from clinicians and other providers regarding the prior authorization process for hepatitis C treatment under MassHealth, the state’s Medicaid program.