Hepatitis C Screening, Retesting, and Treatment Discussion among HIV+ Persons in Care, 2011

Transcription

1 Hepatitis C Screening, Retesting, and Treatment Discussion among HIV+ Persons in Care, 2011

2 Authors Rupali K. Doshi, 1 Christopher G. Wells, 2 Leah Savitsky, 2 William Garre>, 2 Tracy Ma>hews, 1 Marlene Matosky, 1 Laura W. Cheever, 1 Bruce D. Agins 2 (presenter) 1 Health Resources and Services AdministraHon, HIV/ AIDS Bureau 2 New York State Department of Health AIDS InsHtute

3 Disclosures None of the authors have conflicts of interest to disclose.

4 Mortality from HepaHHs C has surpassed HIV in the United States Ly K et al. Ann Intern Med 2012; 156:

5 HIV and HepaHHs C CoinfecHon Many pahents have HIV and HCV 25% HIV are coinfected with HCV in the US Among HIV+ IDUs: up to 80-90% co- infected with HCV (HCV is usually acquired before HIV) Having HIV accelerates liver damage Liver disease is a leading cause of non- AIDS death among HIV+ Ragni MV and Belle SH. J Infect Dis 2001;183: Weber et al for the D:A:D Study Group. Arch Intern Med. 2006;166:

6 HIV/HCV CoinfecHon: Key Management ConsideraHons Screen all HIV+ pahents for HCV before starhng ART Rescreen if negahve and has ongoing risk ART should be considered for all co- infected pahents regardless of CD4 count When treahng both infechons, consider drug- drug interachons If CD4 <200, consider delaying HCV treatment unhl CD4 >200. Guidelines for the Use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents

7 Infected Persons and EsHmated Rates of DetecHon, Referral to Care and Treatment for Persons with HCV Holmberg SD et al. NEJM. 2013;368: Data from NHANES and CHeCS.

8 HAB Performance Measure: HepaHHs C Screening Percentage of pahents for whom HCV screening was performed at least once since the diagnosis of HIV HAB HIV Performance Measures

9 What do we know about the quality of HCV care in people living with HIV?

10 METHODS

11 HIVQUAL- US HIVQUAL- US* supports a web- based performance measurement applicahon developed by the New York State Department of Health supported through funding from HRSA/HAB Ages 13 and above States represented Voluntary submission *HIVQUAL- US is part of the NaHonal Quality Center

12 HIVQUAL- US 128 Ryan White Program- funded clinics across the US self- reported performance measure data in 2011 Eligible pahents: 1 visit in each half of the year Chart review among randomly selected eligible pahents (90% CI +/- 8%)

13 Measures HCV Diagnosis HCV status documented HCV anhbody posihves with HCV RNA tested High- risk negahves retested AcHve IDU; mulhple sexual partners; MSM sexual exposure without barrier protechon; abnormal LFTs Discussion of HCV treatment or further evaluahon

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15 Frequencies Analyses MulHvariate analysis Age [13-18; 19-24; 25-34; 35-44; 45-54; 55-64; >65] Race/Ethnicity [Asian; Black; Hispanic; MulHracial; AI/AN/NH/PI/Other] Sex [Female; Male; MTF TG] Risk Group [IDU; Blood product; Perinatal; Heterosexual; Hetero/IDU; MSM; MSM/IDU] Payer [Medicaid; Medicare; Dual; ADAP/Self- Pay; Private; Unknown; Other] Facility type [hospital; FQHC/non- FQHC clinic; other] Caseload [0-24; 25-99; ; ; ; ; >2000]

16 RESULTS

17 HCV Diagnosis - Frequencies 7,966 HIV+ pahents were eligible for HCV screening 93% (n=7438) have a documented HCV status 19% (1403) of those ever tested for HCV were HCVAb + 86% (1198/1392) of HCVAb+ individuals eligible for HCV RNA teshng were tested; 78% (931) were HCV RNA+

18 HCV Diagnosis: Results Lower rates of HCV screening among: year- olds (82%) Perinatally- infected (87%) FaciliHes with caseload >2000 pahents (85%) Higher rates of HCV screening among: IDU (98%) Mean score = 93%

19 RetesHng high- risk negahves Of 956 high- risk HCVAb- pahents, 605 (63%) were retested Factors associated with reteshng included: Payer (ADAP or self- pay: 75% retested) Clinical senng (FQHC or non- FQHC clinic: 58% retested) Caseload (0-24: 29% retested, >2000: 55% retested)

20 Discussion of HCV treatment Of the 939 with HCV RNA+, 808 (86%) discussed HCV treatment ophons with their provider Lowest rates of HCV treatment discussion were found among: MSM & IDU risk factor (71%) Other facility type (not clinic or hospital) (77%) Caseload 0-24 (74%)

21 LimitaHons Data are self- reported Submission is voluntary: clinics are not randomly sampled Data are generated for purpose of improvement at site- level and not for nahonal performance rates Hierarchical interachons among factors were not tested in this analysis Individual facility impact is not assessed against populahon characterishcs in this analysis

22 Summary In this analysis, IDUs had a higher likelihood of being screened than any other risk groups Uninsured persons had higher HCV reteshng rates than insured persons. Individual and facility factors were not associated with discussion of HCV treatment.

23 Conclusions With new effechve medicahons available, and treatment guidelines changing, new quality measures will need to be developed to reflect the changing the paradigm of HCV care. Formal performance measurement of HCV processes and outcomes is needed to assess quality of care at both local and nahonal levels. Further research is necessary to determine if disparihes in screening and treatment exist.

24 What can we do now? Encourage HIV providers to: Adopt performance measures addressing HCV diagnosis and treatment Implement improvement projects to address gaps in care Implement findings from HRSA/HAB SPNS HepaHHs C Treatment Expansion IniHaHve which idenhfied models of integrated HIV/HCV care.

25 Viral HepaHHs AcHon Plan Revise policies to expand access to teshng, care and treatment services Build capacity to deliver prevenhve and care services Reaching marginalized populahons Monitor outcomes Adapted from John Ward, MD (CDC/NCHHSTP)

26 Contact InformaHon Rupali K. Doshi, MD, MS Medical Officer, Health Resources and Services AdministraHon, HIV/AIDS Bureau, (301) Bruce D. Agins, MD, MPH Medical Director, AIDS InsHtute, NYSDOH Director, HEALTHQUAL InternaHonal, Principal InvesHgator, NaHonal Quality Center,

27 Burden of HepaHHs C Disease Es7mated number living with chronic HCV Deaths due to HCV (per year) Es7mated number living with HIV United States Global 3.2 million 16, million 170 million 190 million 499, million Armstrong GL et al. Ann Intern Med. 2006;144: WHO HIV/AIDS Adapted from John Ward, MD (CDC/NCHHSTP)