Treat Hepatitis C Through a Medical Education Program

The hepatitis C virus (HCV) is a global health concern, because of its progression to cirrhosis, hepatocellular cancer, and liver transplantation, among others.^1,2

On a worldwide scale, it is reported that about 17 million people live with HCV, with as many as 399,000 deaths attributed to HCV-related liver disease in 2017.³ The increasing health care impact of HCV has been viewed as a cause for concern for many years.

About 2.4 million Americans were living with HCV between 2013 and 2016, according to the CDC.⁴

With the highly publicized development of new HCV medications, such as direct-acting antivirals, polymerase inhibitors, and protease inhibitors, as well as improved screening, many were hopeful that HCV could be almost eradicated in the United States. However, millions of Americans have yet to benefit from these curative therapeutic agents. For instance, even though the advent of direct-acting antivirals have demonstrated a significant paradigm shift in the treatment approach of chronic HCV infection, with more favorable adverse effect profiles than older agents and observed cure rates of greater than 90%, there are still patients who do not have access to these life-changing drugs.⁵

Given these noteworthy findings, the United States continues to experience an influx of patients who require proper treatment, even after the Center for Medicaid and Medicaid Services authorized reimbursement for HCV screening for target populations, such as baby boomers and individuals at high risk of infection, as well as the FDA’s approval of drug regimens that include sofobuvir, a novel drug that marked a breakthrough in HCV treatment.⁶

There are several major gaps that exist with the implementation of HCV treatment in clinical practice, which include the diminished engagement level in the care of patients with HCV stemming from either patients or prescribers, lack of early screening at time of care, and limited or no access to HCV services for patients. One of the most notable factors is related to the limited number of specialists who are effectively trained to treat HCV. This poses a considerable challenge to overcome if providers are not aware of the best course of action to take to yield optimal therapeutic benefits for patients with HCV.

Many individuals may not know they have HCV infection and do not necessarily know how to access care and treatment. As a means of addressing this issue, greater awareness and emphasis should be placed on educating gastroenterologists, hepatologists, infectious disease specialists, prescribers, primary-care physicians, and transplant centers for more coordinated and effective care, through a medical education program. The enhanced partnerships among these disciplines can ensure continuum of care from initial diagnosis to treatment.

The program can focus on how to adequately inform patients about therapeutic options that are available as a method to improve access to HCV care. The scope of knowledge promoted through an educational program should focus on 3 tiers that include patients, payers, and prescribers, to achieve a more cohesive and collaborative approach to HCV treatment.

Patients should be educated about the advances that have been made for curing HCV and how this can potentially impact their quality of life. The active involvement of patients can be integral to achieving optimal clinical outcomes. Prescribers should be informed about the importance of engagement with patients to educate the in an impactful manner and provide them with support during the treatment process. Furthermore, there can be the inclusion of an assessment of prescribers’ clinical competence focused on understanding the treatment guidelines that are aimed at improving HCV treatment.⁷ Finally, the educational program should also focus on addressing payer involvement and willingness to provide these high-cost drugs as a means to offset future transmissions and late-stage complications if HCV treatment is delayed.⁷ When evaluating mortality rates related to chronic viral infections, mortality attributed to HCV infection has continued to exceed HIV infection since 2007, so addressing gaps related to the high cost of treatment, patient access, and provider clinical competence, is critical to optimizing the benefits of HCV treatment.⁷

Abimbola Farinde, PharmD, is a pharmacist at Cornerstone Hospital in Webster, Texas.

REFERENCES

• Modi AA, Liang TJ. Hepatitis C: a clinical review. Oral Dis. 2008;14(1):10-14. doi:10.1111/j.1601-0825.2007.01419.x
• Martin MT, Deming P. Closing the gap: the challenge of treating hepatitis C virus genotype 3 infection. Pharmacotherapy. 2017;37(6):735-747. doi:10.1002/phar.1933
• Multicultural HIV and Hepatitis Service. Hepatitis C statistics. Accessed January 19, 2021. https://mhahs.org.au/index.php/en/media-page/statistics/hepatitis-c-statistics
• CDC. CDC estimates nearly 2.4 million Americans living with Hepatitis C. Updated November 6, 2018. Accessed January 19, 2021. https://www.cdc.gov/nchhstp/newsroom/2018/hepatitis-c-prevalence-estimates-press-release.html
• Alkhouri N, Lawitz E, Poordad F. Novel treatment for chronic hepatitis C. closing the remaining gaps. Curr Opin Pharmacol. 2017;37:107-111. doi:10.1016/j.coph.2017.10.001
• Major gaps in hepatitis C care identified as new drugs and screening efforts emerge, Penn study finds [news release]. Philadelphia, PA; July 2, 2014: Penn Medicine News. Accessed January 19, 2021. https://www.pennmedicine.org/news/news-releases/2014/july/major-gaps-in-hepatitis-c-care
• Smyth D, Webster D. Hepatitis C virus infection: accessing drug treatment. CMAJ. 2015;187(15):1113-1114. doi:10.1503/cmaj.150652