Primary Care Providers in Federally Qualified Health Centers Can Treat Hepatitis C Effectively without Ongoing Consultative Support from Specialists

Abstract

Background: Hepatitis C virus (HCV) infection remains underdiagnosed and undertreated, but treatment advances may allow primary care providers to address gaps in care by delivering HCV treatment themselves. Objective: The objective of this study was to evaluate results of an HCV treatment program at a federally qualified health center (FQHC) in rural North Carolina and assess the extent to which program success depends upon ongoing consultative support from specialists. Methods: In this retrospective cohort study, we used data on 381 FQHC patients internally referred for HCV care from January 2015 to December 2018, with follow-up through December 2019. Using modified Poisson regression analyses we compared outcomes during periods with (2015-2016) and without (2017-2018) consultative support. Outcomes included treatment initiation, completion, and cure. We also modeled the likelihood of keeping the first appointment, but because multiple referral attempts were made among nonresponsive patients throughout the study period, we could not compare this outcome in periods with and without consultative support. Results: Of all patients referred for evaluation, 91.3% kept at least 1 appointment, 74.1% initiated treatment, 72% completed treatment, and 68.1% were cured. When comparing periods with and without consultative support, there were no significant differences in treatment initiation ([relative risk (RR): 0.975, 95% confidence interval (CI): 0.871, 1.092], treatment completion (RR: 0.989, 95% CI: 0.953, 1.027), or cure (RR: 0.977, 95% CI: 0.926, 1.031). Conclusions: After 2 years of consultative support from specialists, primary care providers at FQHCs can deliver HCV treatment effectively without ongoing support. However, more research is needed to determine whether our findings are generalizable across primary care settings.