Generalists, specialists must work together to ‘narrow gaps’ in HCV care cascade
VIENNA — In the face of the remaining gaps in the hepatitis C care cascade, timely screening, monitoring and linkage to care by general practitioners coupled with early treatment by specialists could effectively reduce the hepatic and extrahepatic burden of the virus, according to a real-world analysis presented at the International Liver Congress 2019.
“We recognize that with the advent of direct-acting antivirals, high cure rates are incredibly easy to accomplish, but they require us to close the gaps in the hepatitis C care cascade, otherwise we will not be anywhere near the ability to hit the WHO assigned targets,” Nancy S. Reau, MD, from the Rush University Medical Center in Chicago, said during her presentation.
Reau said that while we have clinical guidelines that clearly outline the “standard patient journey from screening to cure,” a 2014 meta-analysis found that there were significantly large gaps at each step of the care cascade including a diagnosis and awareness rate of only 50% and only 16% of patients receiving therapy.
To assess the flow of HCV patients across physician specialists in the U.S. over the course of care, Reau and colleagues retrospectively analyzed two large de-identified national laboratory sets with patient data from 2013 to 2016.
Of the approximate 17 million patients who received HCV screening during the study period, 913,529 received a diagnosis. Over the course of the care cascade, there was an increase in the proportion of patients who switched to HCV specialists such as gastroenterologists, hepatologists and infectious disease specialists.
Generalists such as primary care, family practice and internal medicine physicians ordered 37% of the HCV antibody tests and 15% initiated treatment. In contrast, HCV specialists ordered 3% of screening tests and 37% initiated treatment. The researchers also found that obstetricians and gynecologists ordered 11% of screening tests but only 0.3% initiated treatment.
Most patients who tested positive for HCV antibody (46%) did not receive confirmatory RNA testing. Of those who received a diagnosis, 57% did not receive fibrosis assessment, 47% did not receive genotype testing, and 90% did not receive treatment.
“Significant gaps were identified in all stages of the HCV care cascade, especially from screening to diagnosis and from diagnosis to treatment,” Reau concluded. “These data indicate that although generalists initiate one-third of HCV screening, a growing proportion of patients receive further assessments and treatment by HCV specialists. We have got to find ways to narrow these gaps.” – by Talitha Bennett
Reau NS. Abstract PS-066. Presented at: International Liver Congress; April 10-14, 2019; Vienna, Austria.
Disclosures: Reau reports she is an employee of Rush University Medical Center, which received research support from AbbVie and Gilead Sciences, and she is a consultant for AbbVie, Gilead Sciences, Merck, and Bristol-Myers Squibb.