Friel, Timothy J, MD

Penaloza, Orlando J, MD, FACP

Yozviak, Joseph L, DO, FACP

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineA Novel Approach for a New Era: SuccessfulIntegration of Multidisciplinary, Hepatitis C Carewithin an Established HIV Primary Care PracticeJoseph L. Yozviak DO, FACPLehigh Valley Health Network, joseph.yozviak@lvhn.orgOrlando J. Penaloza MD, FACPLehigh Valley Health Network, Orlando_J.Penaloza@lvhn.orgTimothy J. Friel MDLehigh Valley Health Network, Timothy.Friel@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Hepatology Commons, Infectious Disease Commons, and the Medical SciencesCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtYozviak, J., Penaloza, O., & Friel, T. (2011, April 11-12). A novel approach for a new era: Successful integration of multidisciplinary,hepatitis c care within an established HIV primary care practice. Poster presented at: The First International Conference on ViralHepatitis, Baltimore, MD.A Novel Approach for a New Era:  Successful Integration of Multidisciplinary, Hepatitis C  Care within an Established HIV Primary Care PracticeBackgroundClinical trials have shown that at least 40% of patients with chronic hepatitis C (HCV) achieve sustained virologic response (SVR) with peginterferon/ribavirin (Peg/RBV). Since patients with a history of mental illness, addiction, multiple medical  comorbidities or unstable social situations are commonly  excluded from research trials, SVR is achieved less often in clinical practice. These issues may present management  dilemmas for clinicians unaccustomed to the needs of complex patients. We proposed that integration of an HCV treatment program into an existing multidisciplinary HIV primary care practice would better address these needs, resulting in im-proved treatment outcomes.DescriptionAn internist-led HCV treatment program was integrated into an existing HIV practice in northeastern Pennsylvania employing a successful chronic care model, akin to a patient-centered medical home. The HIV program was comprised of a multi-disciplinary team of providers trained in the complex medical and psychosocial management of patients with HIV and its multiple comorbidities, including the treatment of HCV co-infection. Certain members of this team subsequently appor-tioned part of their clinical time to the development of a new “Hepatitis Care Center,” focused on the treatment of HCV-monoinfected patients within the region. Principle staff of the new HCV program included general inter-nists with experience in viral hepatitis management, a licensed clinical social worker (LCSW), registered-nurse/case manager (RN), dietician, and clinical support staff (MAs, LPN). Fifty per-cent of the staff was bilingual and bicultural. Intensive patient education and adherence support were provided by the RN and LCSW, focusing on psychosocial issues, coordination of mental health services and resolving barriers to care. Emphasis was placed on stabilization of modifiable psychiatric and medical comorbidities to allow for initiation of Peg/RBV in patients who would not normally receive treatment. Treatment outcomes were continually monitored.Results•  76 patients initiated Peg/RBV.  None were coinfected with HIV.•  Final outcome data is available in 61 patients.  15 patients remain on Peg/RBV.•  Adverse events (AEs) were typical of Peg/RBV. •  Reasons for discontinuation (18, 29%): n  Medical (6, 10%): Symptomatic CAD (1), Encephalopathy (2), Psoriasis (1), Hepatocellular Carcinoma (1), New Onset Type 1 Diabetes/DKA (1)n  Psychiatric (2, 3%): Depression (1), Aggressive Behavior (1)n  Other: Self Choice (5, 8%), Addiction (3, 5%), Relocation (1), Incarceration (1)•  SVR was achieved in 35 patients (57%) overall, GT 1 (23, 51%), GT 2 (6, 86%), GT 3 (4, 67%), GT 4 (1, 50%), and  GT 6 (1, 100%).Joseph L. Yozviak DO, FACP, Orlando J. Penaloza MD, FACP and Timothy J. Friel MD, Lehigh Valley Health Network, Allentown, Pennsylvania, U.S.A.ConclusionsIntegration of HCV monoinfection services into an existing multidisciplinary HIV clinical practice resulted in high rates of therapy completion and SVR in a diverse patient population. Providers experienced in the care of HIV and its many medical and psychosocial comorbidities are well poised to manage the diverse and complex needs of patients living with HCV in their communities. Focusing efforts on education, adherence sup-port, health stabilization and patient preparedness for treat-ment allowed Peg/RBV to be provided to a broader population. Further evaluation of this model of care is necessary in HIV treatment centers and other patient-centered medical homes, where medical, case management, mental health, and nutrition services may be co-located. Table 1: DemographicsSex  Male 37 (49%)Female 39 (51%)Race/Ethnicity White 33 (43%)Hispanic 31 (41%)Black 8 (11%)Asian 2 (3%)Egyptian 2 (3%) 1 2 3 4 614%9% 3% 1%73%* No Black patients with genotype 2 HCV were treated.Figure 1: Genotype Distribution02040608010071% (45) 69% (18)73% (19)57% (4)100% (4) Total White Hispanic Black OtherN=6302040608010057% (35)51% (23)86% (6)67% (4)50% (1)100% (1) Total Genotype 1 Genotype 2 Genotype 3 Genotype 4 Genotype 6N=61020406080100 Total White Hispanic Black57%51%86%71%61%100%54% 52%75%14%  17% Total Genotype 1 Genotype 2N=61Figure 2: Peg/RBV Completion Percentage by Race/EthnicityFigure 3: SVR by GenotypeFigure 4: SVR by Selected Genotypes* and Race/Ethnicity

A Novel Approach for a New Era: Successful Integration of Multidisciplinary, Hepatitis C Care within an Established HIV Primary Care Practice

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A Novel Approach for a New Era: Successful Integration of Multidisciplinary, Hepatitis C Care within an Established HIV Primary Care Practice

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