7 research outputs found
Nurse Case Management to Improve the Hepatitis C Care Continuum in HIV Co-Infection: A Randomized Controlled Trial
Background. All-oral direct acting antivirals (DAAs) provide an unprecedented opportunity to eliminate hepatitis C virus (HCV) as a public health threat. But challenges across the care continuum persist. These challenges are particularly poignant for persons co-infected with HIV who are high-priority to cure but not well engaged in HCV care. Strategies to improve the HCV care continuum for this population are urgently needed.
Methods. The Care2Cure study was a single-blinded randomized controlled trial to test the effect of a multi-component HCV nurse case management intervention (nurse-initiated referral, strengths-based education, patient navigation, and care coordination) on linkage to HCV care and time to DAA initiation. Adults co-infected with HIV/HCV not engaged in HCV care were recruited from an urban, outpatient infectious disease practice.
Results. Between July 2016 and February 2018, 68 participants were randomized to receive nurse case management (n=35) or an HCV fact sheet (n=33) in addition to usual care. Participants were primarily Black/African-American (81%) and low income (98% on public health insurance). At day 60, 47% of nurse case management participants linked to HCV care, compared to 25% of usual care participants (p=0.036 by z test for difference in proportions; confidence bound 3.2%-40.9%). There was no significant difference in time to treatment initiation by Kaplan Meier estimates. In logistic regression, participants who drank alcohol were more likely to schedule an HCV appointment (adjusted odds ratio [aOR]=3.8), attend the appointment (aOR=3.8), and be prescribed DAAs (aOR=4.2). Knowing someone who cured HCV increased the likelihood of being prescribed (aOR=5.2) and initiating (aOR=8.0) DAAs. A higher CD4 cell count was associated with greater odds of scheduling an HCV appointment (aOR=1.002). Participants taking medication-assisted treatment (MAT) were less likely to be prescribed DAAs (aOR=0.25).
Conclusions. These results support provision of nurse case management to link adults co-infected with HIV to HCV care. Interventions that continue from linking to care through cure are needed to achieve HCV elimination in this high-priority population. Capitalizing on social networks and treatment pathways for patients drinking alcohol may help improve the HCV care continuum. Integrated substance use and HCV care to engage patients taking MAT should be considered
Nurse Case Management to Improve the Hepatitis C Care Continuum in HIV Co-Infection: A Randomized Controlled Trial
Background. All-oral direct acting antivirals (DAAs) provide an unprecedented opportunity to eliminate hepatitis C virus (HCV) as a public health threat. But challenges across the care continuum persist. These challenges are particularly poignant for persons co-infected with HIV who are high-priority to cure but not well engaged in HCV care. Strategies to improve the HCV care continuum for this population are urgently needed.
Methods. The Care2Cure study was a single-blinded randomized controlled trial to test the effect of a multi-component HCV nurse case management intervention (nurse-initiated referral, strengths-based education, patient navigation, and care coordination) on linkage to HCV care and time to DAA initiation. Adults co-infected with HIV/HCV not engaged in HCV care were recruited from an urban, outpatient infectious disease practice.
Results. Between July 2016 and February 2018, 68 participants were randomized to receive nurse case management (n=35) or an HCV fact sheet (n=33) in addition to usual care. Participants were primarily Black/African-American (81%) and low income (98% on public health insurance). At day 60, 47% of nurse case management participants linked to HCV care, compared to 25% of usual care participants (p=0.036 by z test for difference in proportions; confidence bound 3.2%-40.9%). There was no significant difference in time to treatment initiation by Kaplan Meier estimates. In logistic regression, participants who drank alcohol were more likely to schedule an HCV appointment (adjusted odds ratio [aOR]=3.8), attend the appointment (aOR=3.8), and be prescribed DAAs (aOR=4.2). Knowing someone who cured HCV increased the likelihood of being prescribed (aOR=5.2) and initiating (aOR=8.0) DAAs. A higher CD4 cell count was associated with greater odds of scheduling an HCV appointment (aOR=1.002). Participants taking medication-assisted treatment (MAT) were less likely to be prescribed DAAs (aOR=0.25).
Conclusions. These results support provision of nurse case management to link adults co-infected with HIV to HCV care. Interventions that continue from linking to care through cure are needed to achieve HCV elimination in this high-priority population. Capitalizing on social networks and treatment pathways for patients drinking alcohol may help improve the HCV care continuum. Integrated substance use and HCV care to engage patients taking MAT should be considered
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Cost of Hepatitis C care facilitation for HIV/Hepatitis C Co-infected people who use drugs
Using data from a randomized trial, we evaluated the cost of HCV care facilitation that supports moving along the continuum of care for HIV/HCV co-infected individuals with substance use disorder.
Participants were HIV patients residing in the community, initially recruited from eight US hospital sites. They received HCV care facilitation (n = 51) or treatment as usual (n = 62) for up to six months. We used micro-costing methods to evaluate costs from the healthcare sector and patient perspectives in 2017 USD. We conducted sensitivity analyses varying care facilitator caseloads and examined offsetting savings using participant self-reported healthcare utilization.
The average site start-up cost was 4320-20 (site range: 30) for care facilitation visits and contacts, 130- 70 (site range: 180) for overhead. In sensitivity analyses applying a weekly caseload of 10 participants per care facilitator (versus 1–6 observed in the trial), the total mean weekly care facilitation cost from the healthcare sector perspective decreased to 7. There were no significant differences in other healthcare service costs between participants in the intervention and control arms.
Weekly HCV care facilitation costs were approximately 110 at a real-world setting maximum caseload of 10 participants per week. No healthcare cost offsets were identified during the trial period, although future savings might result from successful HCV treatment.
•Care facilitation weekly cost was 110 per person) assuming a more realistic caseload.•Outreach and supervision represented the largest share of care facilitation costs.•No healthcare cost offsets were identified during the trial period
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Health economic design for cost, cost-effectiveness and simulation analyses in the HEALing Communities Study
•The HEALing Communities Study is designed to implement and evaluate the Communities That HEAL intervention to reduce opioid overdose deaths.•The HCS includes a health economics study.•Costs of CTH will be estimated for multiple perspectives.•The health economics study includes cost-effectiveness analyses and simulation modeling.
The HEALing Communities Study (HCS) is designed to implement and evaluate the Communities That HEAL (CTH) intervention, a conceptually driven framework to assist communities in selecting and adopting evidence-based practices to reduce opioid overdose deaths. The goal of the HCS is to produce generalizable information for policy makers and community stakeholders seeking to implement CTH or a similar community intervention. To support this objective, one aim of the HCS is a health economics study (HES), the results of which will inform decisions around fiscal feasibility and sustainability relevant to other community settings.
The HES is integrated into the HCS design: an unblinded, multisite, parallel arm, cluster randomized, wait list–controlled trial of the CTH intervention implemented in 67 communities in four U.S. states: Kentucky, Massachusetts, New York, and Ohio. The objectives of the HES are to estimate the economic costs to communities of implementing and sustaining CTH; estimate broader societal costs associated with CTH; estimate the cost-effectiveness of CTH for overdose deaths avoided; and use simulation modeling to evaluate the short- and long-term health and economic impact of CTH, including future overdose deaths avoided and quality-adjusted life years saved, and to develop a simulation policy tool for communities that seek to implement CTH or a similar community intervention.
The HCS offers an unprecedented opportunity to conduct health economics research on solutions to the opioid crisis and to increase understanding of the impact and value of complex, community-level interventions