Patient navigation associated with increased care, treatment in hepatitis C

Patients with hepatitis C virus (HCV) infection who receive patient navigation may have better linkage to care and be more likely to receive direct-acting antiviral treatment (DAAT), according to a recent study.

Researchers performed a pre-post analysis to evaluate the effectiveness of a patient navigation program among older adults (those born between 1945 and 1965) who tested positive for HCV in a safety-net health system. Those in the usual care group were enrolled from June 2013 to May 2015, and those in the patient navigation group were enrolled from January 2016 to December 2017. In the patient navigation program, patients who had not been seen in the HCV treatment clinic within three months of a positive HCV RNA result were contacted by phone up to three times to schedule an appointment and were sent a letter if they could not be reached by phone. Predefined scripts were used to explain the test results and DAAT. In addition, the HCV clinic expanded in 2016 to offer patient education and assistance until sustained virologic response was achieved. The results of the study were published May 13 by Clinical Gastroenterology and Hepatology.

The study included 1,353 patients, 769 in the usual care group and 584 in the patient navigation group. Sixty-two percent were Black, 61% did not have insurance, and 16% were homeless. Patients were followed until death, until sustained virologic response was achieved, or until the study ended in July 2019. Odds of linkage to care and treatment initiation within six months were significantly higher in the patient navigation group versus the usual care group (odds ratios, 3.7 [95% CI, 2.9 to 4.8] and 3.2 [95% CI, 2.3 to 4.2], respectively). These increased odds were also noted at 12 months (odds ratios, 3.4 [95% CI, 2.7 to 4.3] and 2.3 [95% CI, 1.7 to 3.0], respectively). At six months and 12 months, 50.1% and 58.5% of the patient navigation cohort and 22.3% and 37.6% of the usual care cohort had received HCV treatment. Sustained virologic response did not differ between the patient navigation and usual care cohorts among those linked to treatment (86.9% vs. 86.1%; P=0.78) but did differ between the cohorts overall (34.9% vs. 18.2%).

The researchers noted that trial was not conducted in a parallel timeframe and that they could not analyze barriers to care by subgroups, among other limitations. They concluded that the use of a patient navigation program significantly increased overall linkage to care and decreased time to care among older adults in a large safety-net health system. “The implication of this finding is that implementation of a program that increases the proportion linked to care will lead to downstream increases in HCV cure,” the authors wrote. “The net impact of this type of program is to help move the needle towards HCV elimination.”