Ryan White Program Addressing Coinfection with Viral Hepatitis
May 2, 2013 • 0 comments • By Rupali K. Doshi, MD, MS, Medical Officer, HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services and Laura W. Cheever, MD, ScM, Acting Associate Administrator, HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
This attention is warranted given that, according to the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, an estimated 33% of persons living with HIV are coinfected with the hepatitis B virus (HBV) or hepatitis C virus (HCV). Further, the progression of viral hepatitis is accelerated among persons with HIV; therefore, persons who are coinfected with HIV and HCV experience greater liver-related health problems than non-HIV infected persons. The CDC also notes that while “antiretroviral therapy has extended the life expectancy of people living with HIV (PLWH), liver disease—much of which is related to hepatitis B and C infection—has become the leading cause of non-AIDS-related deaths among this population.”
Hepatitis C Treatment Expansion Initiative
One important initiative is the Hepatitis C Treatment Expansion Initiative. Funded by HRSA/HAB as a Special Project of National Significance (SPNS), this initiative supports two groups of Ryan White program grantees that have received $80,000 per year for two years to test a new model of integrating hepatitis C treatment into their clinical practice. The overall goal of the initiative is to enable sites to increase the number of co-infected patients treated for hepatitis C.Among the presentations at the most recent Ryan White HIV/AIDS Program Grantee Meeting (November 27-29, 2012) were several by participants in this initiative, including AIDS Care Group
The University of South Florida, which has a cooperative agreement to serve as the training and evaluation center for this SPNS initiative, also presented at the grantee meeting. Their presentation, “Implementing HCV Treatment Programs in Comprehensive HIV Clinics,”
- Primary care delivery with expert back-up
- Integrated care without a designated HCV clinic (expert consultation used for severe complications)
- Integrated care with a designated internal HCV clinic
- Co-located care with specialist who manages treatment at Ryan White clinical site
Project ECHO™ Adapted by Ryan White Grantees
Project ECHO™For example, Community Health Center, Inc., of Connecticut
In addition to clinical collaboration, Project ECHO™ and AIDS Education and Training Centers (AETCs) are working together to increase access to hepatitis C care and treatment. The Northwest AETC
One clinical site working with the Northwest AETC is Idaho State University’s (ISU) Department of Family Medicine, which is also a recipient of the SPNS Hepatitis C grant. ISU has expanded its provider education around hepatitis C and increased the numbers of patients treated. Of the 120 HIV+ patients at ISU, 20 are HCV antibody positive. Since beginning their treatment program, 6 patients have completed treatment (5 sustained virologic response, 1 relapse), and 4 others are currently on therapy. They are now planning to launch expanded hepatitis C screening based on the revised CDC recommendations, which call for a one-time HCV test for all “baby boomers.”
These are just a few of examples of approaches underway across the Ryan White HIV Program to address viral hepatitis. As we continue our efforts to deliver high quality HIV care to clients and collaborate with federal colleagues to implement the Viral Hepatitis Action Plan, we will continue to share information about successful approaches that can be adapted by others both in and beyond the Ryan White network.
HAB colleagues Adan Cajina, MPH; Diana Travieso Palow, MPH, MS, RN; Tracy Matthews, MHA, RN; Marlene Matosky, MPH, RN, and the Ryan White grantees mentioned in the article also contributed to this post.
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