Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Published on Jun 9, 2011in The New England Journal of Medicine70.67
· DOI :10.1056/NEJMoa1009370
Sanjeev Arora22
Estimated H-index: 22
Karla Thornton9
Estimated H-index: 9
+ 12 AuthorsClifford R. Quails49
Estimated H-index: 49
Methods We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response. Results A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, −9.2 to 10.7; P = 0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P = 0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites. Conclusions The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.)
  • References (24)
  • Citations (393)
Published on Jun 3, 2010in The New England Journal of Medicine70.67
Eli Y. Adashi61
Estimated H-index: 61
H. Jack Geiger3
Estimated H-index: 3
Michael D. Fine1
Estimated H-index: 1
The Patient Protection and Affordable Care Act enables community health centers to serve nearly 20 million new patients while adding an estimated 15,000 providers to their staffs by 2015. Dr. Eli Adashi and colleagues describe the “new” community health centers.
Published on Dec 1, 2009in Hepatology14.97
Michael L. Volk27
Estimated H-index: 27
(UM: University of Michigan),
Rachel S. Tocco4
Estimated H-index: 4
(UM: University of Michigan)
+ 1 AuthorsAnna S. Lok84
Estimated H-index: 84
(UM: University of Michigan)
Despite dramatic improvements in antiviral therapy for hepatitis C, there is reason to believe that the uptake of antiviral therapy remains limited. The aims of this study were to determine the number of patients being treated with antiviral therapy in the U.S., to estimate the public health impact of these treatment patterns, and to identify barriers to treatment for patients with hepatitis C. Data on the number of new patient pegylated interferon prescriptions each year, from 2002–2007, was ob...
Published on Mar 20, 2009in Journal of Clinical Oncology28.25
Sean F. Altekruse30
Estimated H-index: 30
Katherine A. McGlynn55
Estimated H-index: 55
Marsha E. Reichman23
Estimated H-index: 23
Purpose Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide. Incidence rates are increasing in the United States. Monitoring incidence, survival, and mortality rates within at-risk populations can facilitate control efforts. Methods Age-adjusted incidence trends for HCC were examined in the Surveillance, Epidemiology, and End Results (SEER) registries from 1975 to 2005. Age-specific rates were examined for birth cohorts born between 1900 and 1959. Age-adjusted...
Published on Jan 15, 2009in The New England Journal of Medicine70.67
M. Rodriguez-Torres38
Estimated H-index: 38
Lennox J. Jeffers43
Estimated H-index: 43
(UM: University of Miami)
+ 4 AuthorsPaul L. Martin130
Estimated H-index: 130
(Hoffmann-La Roche)
Background Race has been shown to be a factor in the response to therapy for hepatitis C virus (HCV) infection, and limited data suggest that ethnic group may be as well; however, Latinos and other ethnic subpopulations have been underrepresented in clinical trials. We evaluated the effect of Latino ethnic background on the response to treatment with peginterferon alfa-2a and ribavirin in patients infected with HCV genotype 1 who had not been treated previously. Methods In a multicenter, open-la...
Published on Nov 1, 2008in Hepatology14.97
Jennifer Tan3
Estimated H-index: 3
(UCLA: University of California, Los Angeles),
Tom A. Joseph2
Estimated H-index: 2
(UCLA: University of California, Los Angeles),
Sammy Saab55
Estimated H-index: 55
(UCLA: University of California, Los Angeles)
The prevalence of chronic hepatitis C infection in U.S. prisons is 12% to 31%. Treatment of this substantial portion of the population has been subject to much controversy, both medically and legally. Studies have demonstrated that treatment of chronic hepatitis C with pegylated interferon (PEG IFN) and ribavirin is a cost-effective measure in the general population; however, no study has addressed whether the same is true of the prison population. The aim of this study was to determine the cost...
Published on May 1, 2008in American Journal of Public Health5.38
Christine M. Rousseau1
Estimated H-index: 1
George N. Ioannou39
Estimated H-index: 39
(UW: University of Washington)
+ 4 AuthorsJason A. Dominitz56
Estimated H-index: 56
(UW: University of Washington)
Objectives. We examined the association between race and hepatitis C virus (HCV) evaluation and treatment of veterans in the Northwest Network of the Department of Veterans Affairs (VA).Methods. In our retrospective cohort study, we used medical records to determine antiviral treatment of 4263 HCV-infected patients from 8 VA medical centers. Secondary outcomes included specialty referrals, laboratory evaluation, viral genotype testing, and liver biopsy. Multiple logistic regression was used to a...
Published on Dec 27, 2007in Hepatology14.97
Lisa I. Backus21
Estimated H-index: 21
Derek B. Boothroyd29
Estimated H-index: 29
+ 1 AuthorsLarry A. Mole24
Estimated H-index: 24
The currently recommended treatment for hepatitis C virus (HCV) infection is pegylated interferon alfa (PEG-INF) and ribavirin, which can be difficult to tolerate. More information about predicting sustained virologic response (SVR) may allow more informed treatment decisions to be made. This retrospective observational cohort study identified predictors of SVR to PEG-INF and ribavirin in routine medical practice at 121 Department of Veterans Affairs facilities. Among 5,944 patients infected wit...
Published on Dec 19, 2007in Hepatology14.97
Matthew E. Wise18
Estimated H-index: 18
(UCLA: University of California, Los Angeles),
Stephanie R. Bialek25
Estimated H-index: 25
(CDC: Centers for Disease Control and Prevention)
+ 2 AuthorsFrank Sorvillo14
Estimated H-index: 14
(UCLA: University of California, Los Angeles)
The disease burden and mortality from hepatitis C are predicted to increase in the United States as the number of persons with long-standing chronic infection grows. We analyzed hepatitis C mortality rates derived from US Census and multiple-cause-of-death data for 1995-2004. Deaths were considered hepatitis C–related if: (1) hepatitis C was the underlying cause of death, (2) chronic liver disease was the underlying cause and hepatitis C was a contributing cause, or (3) human immunodeficiency vi...
Published on Dec 1, 2007in Hepatology14.97
Fasiha Kanwal41
Estimated H-index: 41
(SLU: Saint Louis University),
Tuyen Hoang13
Estimated H-index: 13
+ 5 AuthorsSteven M. Asch63
Estimated H-index: 63
(UCLA: University of California, Los Angeles)
Treatment with interferon and ribavirin is effective in patients with chronic infection with hepatitis C virus (HCV). Previous data indicate that treatment rates are suboptimal. We sought to identify patient and provider-level predictors of treatment receipt in HCV by conducting a retrospective cohort study of 5701 HCV patients in a large regional Veteran’s Administration (VA) healthcare network. We also determined the degree of variation in treatment rates attributable to patient, provider, and...
Published on Oct 1, 2007in Hepatology14.97
Ira M. Jacobson65
Estimated H-index: 65
(Cornell University),
Robert S. Brown76
Estimated H-index: 76
(Columbia University)
+ 227 AuthorsEliot Godofsky1
Estimated H-index: 1
This prospective, multicenter, community-based and academic-based, open-label, investigator-initiated, U.S. study evaluated efficacy and safety of pegylated interferon (PEG-IFN) alfa-2b plus a flat or weight-based dose of ribavirin (RBV) in adults with chronic hepatitis C. Patients (n = 5027) were randomly assigned to receive PEG-IFN alfa-2b 1.5 μg/kg/week plus flat-dose (800 mg/day) or weight-based (800-1400 mg/day) RBV for 48 weeks (patients with genotype 1, 4, 5, or 6) and for 24 or 48 weeks ...
Cited By393
Published on Dec 1, 2019in BMC Health Services Research1.93
Vera Yakovchenko4
Estimated H-index: 4
(Edith Nourse Rogers Memorial Veterans Hospital),
Rendelle E. Bolton7
Estimated H-index: 7
(Brandeis University)
+ 1 AuthorsAllen L. Gifford38
Estimated H-index: 38
(BU: Boston University)
In 2014, the Department of Veterans Affairs (VA) adopted a screening test policy for hepatitis C virus (HCV) in all “Baby Boomers” - those born between 1945 and 1965. About 1 in 12 Veterans were estimated to be infected with HCV yet approximately 34% of the birth cohort remained untested. Early HCV diagnosis and successful antiviral treatment decrease the risk of onward transmission, cirrhosis, hepatocellular carcinoma, liver transplant, and death. Implementing evidence-based HCV screening in pr...
Sundari R. Mase (WHO: World Health Organization), Ratima Samron (Mayo Clinic)+ 10 AuthorsAmera Khan
Abstract Background Tuberculosis (TB) Regional Training and Medical Consultation Centers (RTMCCs) were established in 2005 for TB medical consultation, training and education in the United States. A medical consultation database (MCD) captured all consultations provided by RTMCCs; we report on those provided from June 1, 2010 to May 31, 2014. Methods All MCD consultations during 2010-2014 were categorized into: provider type, setting, consultation topic, and patient age. We analyzed data frequen...
Published on Apr 1, 2019in International Journal of Drug Policy4.53
Marguerite E. Beiser , Kamala Smith + 2 AuthorsTravis P. Baggett15
Estimated H-index: 15
(Harvard University)
Abstract Background Hepatitis C virus (HCV) infection prevalence is high among adults who experience homelessness but data on HCV treatment outcomes are limited in this population. We examined HCV treatment engagement and outcomes in a cohort of homeless-experienced adults treated through an innovative community-based primary care program in Boston, Massachusetts, USA. Methods We conducted a retrospective chart review of individuals referred for HCV treatment at Boston Health Care for the Homele...
Published on Sep 12, 2019in Clinical Infectious Diseases9.05
Brianna L. Norton5
Estimated H-index: 5
(Albert Einstein College of Medicine),
Alain H. Litwin4
Estimated H-index: 4
(Clemson University)
Published on Sep 12, 2019in Journal of General Internal Medicine4.61
Michael Hochman2
Estimated H-index: 2
(SC: University of Southern California),
Steven M. Asch63
Estimated H-index: 63
(Stanford University)
Published on Sep 11, 2019in Journal of Community Health1.57
Hepatitis C (HCV) care cascades have been described in diverse clinical settings, patient populations and countries, highlighting the steps in HCV care where improvements can be made and resources allocated. However, more research is needed to examine barriers to HCV treatment in rural, underserved populations and in Federally Qualified Health Centers (FQHCs). As part of a quality improvement (QI) project, this study aimed to describe and evaluate the HCV treatment cascade in an FQHC serving a l...
Published on Sep 4, 2019in Journal of General Internal Medicine4.61
Ryan McBain2
Estimated H-index: 2
(AN: RAND Corporation),
Jessica Sousa (AN: RAND Corporation)+ 5 AuthorsShira H. Fischer8
Estimated H-index: 8
(AN: RAND Corporation)
Background Extension for Community Health care Outcomes (ECHO) and related models of medical tele-education are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical tele-education models of healthcare delivery in terms of improved provider- and patient-related outcomes.
Published on May 21, 2019in Annals of Internal Medicine19.32
Bruce Struminger4
Estimated H-index: 4
(UNM: University of New Mexico),
Sanjeev Arora22
Estimated H-index: 22
(UNM: University of New Mexico)
Published on Sep 1, 2019
Grace L. Su35
Estimated H-index: 35
(UM: University of Michigan)
Published on Jun 1, 2019in Gastroenterology19.23
Holly Knotowicz (Boston Children's Hospital), Angela Haas5
Estimated H-index: 5
(Boston Children's Hospital)
+ 2 AuthorsPooja Mehta (CU: University of Colorado Boulder)
View next paperAcademic Health Center Management of Chronic Diseases through Knowledge Networks: Project ECHO