Strategies to Simplify the HCV Care Continuum

This program is supported by an educational grant from AbbVie, Inc.

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Program Director and Faculty
Stacey Trooskin, MD, PhD, MPH
Clinical Assistant Professor of Medicine
Division of Infectious Diseases
Perelman School of Medicine
University of Pennsylvania
Director of Viral Hepatitis Program
Chief Medical Officer
Philadelphia FIGHT Community Health Centers
Philadelphia, Pennsylvania

Stacey Trooskin, MD, PhD, MPH, has disclosed that she has received consulting
fees and funds for research support from Gilead Sciences.
Faculty
Nancy Reau, MD
Professor of Medicine
Richard B. Capps Chair of Hepatology
Chief, Section of Hepatology 
Associate Director, Solid Organ Transplantation
Rush University Medical Center
Chicago, Illinois
Nancy Reau, MD, has disclosed that she has received consulting fees from
Abbvie, Gilead Sciences, and Intercept and funds for research support from
Abbott.
Program Overview
 Epidemiology of HCV
 Simplified HCV screening, diagnosis, and treatment
 Efficacy and safety of pangenotypic treatment regimens in persons who
inject drugs and persons receiving opioid substitution therapy
 Expansion of the HCV provider pool
 Question and Answer Session
 WHO Vision: Eliminate Viral Hepatitis as a Major Health
Threat by 2030
“A world where viral hepatitis transmission is halted and everyone
living with hepatitis has access to safe, affordable and effective
care and treatment services”

90% reduction in Treatment of 80% of

new chronic HCV 65% reduction in
eligible persons with
infections mortality rates
chronic HCV infection

WHO. https://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/. Accessed November 17, 2020. Slide credit: clinicaloptions.com

 Epidemiology of HCV in the United States

Estimated Number of People Living With HCV, 2013-2016[2]

 ~ 2.4 million
Americans living
with HCV in
2013-2016[1] Persons with
HCV per 100,00
 Nearly 50% population
unaware of their 0-650
651-850
infection[1] 851-1000
1001-1200
1251+

1. Ryerson. MMWR Morb Mortal Wkly Rep. 2020;69:399. 2. HepVu. https://map.hepvu.org/map. Accessed November 17, 2020. Slide credit: clinicaloptions.com
 HCV Epidemic Among Young PWIDs in Rural Settings
 US cases increased from Acute HCV Incidence in People ≤ 30 Years of Age:
Kentucky, Tennessee, Virginia, West Virginia, 2006-2012[2]
850 in 2010 to 2436 in 4.5

No. of Cases per 100,000 Population

2015[1] 4.0 Nonurban
Urban
3.5
‒ Most rapid increase is 3.0
among adults aged 20- 2.5
29 yrs who inject drugs 2.0
1.5
1.0
0.5
0.0
2006 2007 2008 2009 2010 2011 2012
Yr
1. CDC. https://www.cdc.gov/nchhstp/newsroom/2017/Hepatitis-Surveillance-Press-Release.html. Accessed Nov 17, 2020.
2. Zibbell. MMWR Morb Mortal Wkly Rep. 2015;64:453. Slide credit: clinicaloptions.com
 CDC: National HCV Progress Report on 2025 Goals
 Goal: Reduce rate of acute HCV  Goal: Reduce Rate of HCV-Related deaths
infections to ≤ 35,000/yr by 2025 to ≤ 3.00/10OK population by 2025
Estimated* Number of New HCV Infections By Yr Age-Adjusted† Rate of HCV-Related Deaths by Yr

Age-Adjusted Rate per 100,000

60,000 6.00
Estimated Acute Infections, n

50,300 On track
50,000 5.00 5.03 5.01 4.91
44,700 4.42
41,200 4.13
40,000 4.00 3.72
33,900 35,000
30,500 3.00
29,700
30,000 Not on track 3.00

20,000
ₓ 2.00

10,000 1.00

0 0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Yr Yr
*By multiplying the no. of reported cases by a factor to adjust for under-reporting. †
Age-adjusted to the 2000 US standard population.

CDC. National Viral Hepatitis Progress Report 2025. https://www.cdc.gov/hepatitis/policy/NationalProgressReport.htm. Slide credit: clinicaloptions.com
 How Can We Achieve WHO HCV 2030 Elimination Goal?

Prevention Measures Diagnosis and Treatment

Improve blood safety Extend harm reduction Expand testing and

and infection control measures for PWID treatment with DAAs for
those already infected

WHO. Global health sector strategy on viral hepatitis 2016–2021. http://apps.who.int/iris/bitstream/10665/246177/1/WHO-

HIV-2016.06-eng.pdf?ua=1. Accessed November 17, 2020. Slide credit: clinicaloptions.com
 US Preventive Services Task Force:  Screening
Recommendation Updated March 02, 2020

The USPSTF recommends screening adults

Grade B*
18 to 79 years of age for HCV infection
*USPSTF determined with moderate certainty that HCV screening in adults aged 18 to 79 years has substantial net benefit.
Physicians should offer or provide this service.

*https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-c-screening. Slide credit: clinicaloptions.com

 AASLD/IDSA HCV Screening Recommendations
Recommendations for One-Time HCV Testing Rating
One-time, routine, opt-out testing recommended for all persons 18 yrs of age or I, B
older
One-time testing recommended for all persons younger than 18 yrs of age with
exposures, activities, or conditions/circumstances associated with increase HCV I, B
infection risk
Prenatal testing as part of routine prenatal care recommended for each pregnancy I, B
Periodic repeat testing should be offered to all individuals with exposures, activities,
IIa, C
or conditions/circumstances associated with increased HCV exposure risk
Annual testing recommended for: all individuals who inject drugs; men with HIV
infection who have unprotected sex with men; men who have sex with men and are IIa, C
taking HIV pre-exposure prophylaxis

*AASLD/IDSA HCV guidance. https://www.hcvguidelines.org/evaluate/testing-and-linkage. Slide credit: clinicaloptions.com

 What Does Simplified Care Delivery Entail?

Simplified care delivery

Simplified Non-specialist Decentralized Simple

testing, diagnosis providers to care in the management
and treatment manage HCV community guidelines and
protocols


Enable Enable Need

Conceptual slides based on Hellard. J Hepatol. 2018;68:383. Cooke. Lancet Gastroenterol Hepatol. 2019;4:135. Slide credit: clinicaloptions.com
 Initial HCV Testing and Pre-Treatment Assessment

Quantitative Assessment
HCV- Liver HAV, HBV,
HCV RNA HCV of potential
antibody fibrosis HIV
genotype DDIs;
test (VL) assessment testing
Treatment
? ? ?

https://www.hcvguidelines.org/evaluate/testing-and-linkage. https://www.hcvguidelines.org/evaluate/monitoring. Slide credit: clinicaloptions.com

 AASLD/IDSA Simplified Treatment Guidelines for
Treatment-Naïve Patients Without Cirrhosis
Exclude Advanced Fibrosis/Cirrhosis
(No biopsy required)

Screen for DDI

HIV/HBsAg testing

Pangenotypic Therapy
GLE/PIB 8 weeks or SOF/VEL 12 weeks

Minimal Monitoring
(No HCV-related laboratory monitoring required)

Assess for Cure SVR12

Risk Reduction

https://www.hcvguidelines.org/treatment-naive/simplified-treatment. Slide credit: clinicaloptions.com

Eligibility for Simplified Treatment

Eligible for Simplified Treatment

Adults with HCV infection (any genotype); treatment-naive and without cirrhosis

Not Eligible for Simplified Treatment

Prior HCV treatment
Cirrhosis
Known or suspected hepatocellular carcinoma
Prior liver transplantation
HIV or HBsAg positive
Current pregnancy

https://www.hcvguidelines.org/treatment-naive/simplified-treatment. Slide credit: clinicaloptions.com

The DeLIVER Care Van to Optimize HCV Screening and
Fibrosis Staging
 Analysis of feasibility of converting a Characteristic HCV Ab- HCV Ab+
university shuttle bus into a mobile Median age, yrs 54 54
medical unit Male, % 63 66
Race, %
 Provided HCV screening and fibrosis  Black
32 30
35 45
staging to communities in San Francisco,  White 6 1
California, January 2019 - October 2019  Asian/Pacific Islander 4 8
(N = 494 screened)  Native American 23 16
 Other
 HCV Ab+ patients offered venipuncture Fibrosis ≥ F2, % 23 48
for confirmatory HCV RNA and reflex Past/current IVDU, % 27/16 87/54
genotyping, FibroScan, HCV counseling, Hx incarceration > 24 hrs, % 40 76
and linkage to care Rent or own housing in past
28 19
12 mos, %
‒ At street outreach sites, FibroScan often
performed on clients awaiting Ab results

Price. AASLD 2019. Abstr 594. https://www.gastroendonews.com/Article/PrintArticle?articleID=57472. Slide credit: clinicaloptions.com

The DeLIVER Care Van:
HCV Screening and Patient Evaluation Results
 494 clients completed HCV
seroprevalence tests at: 77% of HCV
200 Ab+ had
‒ Street outreach, 65% 167 venipuncture

139
‒ Community events, 19% 150

Participants (n)
128 42% with
venipuncture
‒ Methadone clinic, 16% 100 were HCV RNA+

54
50

0
FibroScan HCV Venipuncture HCV RNA+
Performed Antibody Performed
Positive
Price. AASLD 2019. Abstr 594. https://www.gastroendonews.com/Article/PrintArticle?articleID=57472. Slide credit: clinicaloptions.com
 Drug-Drug Interactions With HCV Treatments
No clinically significant interaction expected
Illicit/Recreational Drug SOF SOF/VEL SOF/VEL/VOX GLE/PIB GZR/EBR
Potential interaction that may require dose adjustment, Amphetamine
altered administration timing, or additional monitoring Cannabis
Should not be coadministered Cocaine
Diamorphine
Lipid-Lowering Drug SOF SOF/VEL SOF/VEL/VOX GLE/PIB GZR/EBR
Diazepam
Atorvastatin
Fentanyl
Bezafibrate γ-hydroxybutyrate
Ezetimibe Ketamine
Fenofibrate MDMA
Fluvastatin Mephedrone

Gemfibrozil Methadone
Methamphetamine
Lovastatin
Oxycodone
Pitavastatin
Phencyclidine
Pravastatin
Temazepam
Rosuvastatin
Simvastatin

Pawlotsky. J Hepatol. 2020;73:1170. Slide credit: clinicaloptions.com

 99.9% of People Suffering From HCV Can Be Cured
Through Pangenotypic Regimens

This should be easy - straightforward screening and an effective cure.

How do we get therapy to those infected?

Feld. NEJM. 2015;373:2599. Foster. NEJM. 2015:373;2608. Zeuzem. NEJM 2018;378:354. Puoti. J Hepatol. 2018;69:293. 5.
Bourliere. NEJM. 2017;376:2134. Bourliere. Lancet Gastroenterol Hepatol. 2018;3:559. Wyles. J Hepatol. 2018;68:S23. Slide credit: clinicaloptions.com
 SIMPLIFY: SOF/VEL for 12 Wks in PWID
Characteristics Participants (N = 103)
 Single-arm, multicenter trial Median age, yrs (SD) 48 (41-53)
Mar-Oct 2016 Male sex, n (%) 74 (72)
HCV GT 1/2/3/4, n 36/5/60/2
 N = 103 participants with chronic Cirrhosis (Fib-4), n (%) 9 (9)
HCV (GT 1-6) treated with 12 Unstable housing, n (%) 24 (23)
wks SOF/VEL provided in Any IVDU in past 6 mos, n (%) 103 (100)
electronic blister packs Any IVDU in past 30 days, n (%) 76 (74)
At least daily IVDU in past 30 days, n (%) 27 (26)
‒ Recruited from hospital- and Alcohol use in past 30 days, n (%) 62 (60)
community-based clinics History of OST use, n (%) 84 (82)
Current OST, n (%)
‒ Excluded HIV coinfection and/or  Methadone 45 (44)
decompensated liver disease  Buprenorphine 4 (4)
 Buprenorphine-naloxone 12 (12)

Grebely. Lancet Gastroenterol Hepatol. 2018;3:153. Grebely. Clin Infect Dis. 2016;63:1479. Slide credit: clinicaloptions.com
 SIMPLIFY: Injection Drug Use and Treatment Adherence
Self-Reported Injection Overall Treatment Adherence[2]a
Drug Use During Therapy[1],a
100 100 94 98 99

80 80

Adherence (%)
IVDU (%)

60 60

40 40

20 20

0 0
Baseline Week 4 Week 8 Week 12 Daily Blister Weekly Self-
Pack Blister Pack reported
Any Other opioids Cocaine
Heroin Methamphetamine

1. Gilead Sciences. EPCLUSA US full Prescribing Information. 2. Cunningham. Int J Drug Policy. 2018;62:14. Slide credit: clinicaloptions.com
 SIMPLIFY: Efficacy of SOF/VEL in PWID With Chronic HCV
 6/103 patients did not have SVR12 (4 LTFU, 1 drug overdose death, 1
reinfection) SVR12: Overall and By Baseline Drug Use
(Intention-to-Treat Analysis)
94 95 96 94 96
100

80
SVR12 (%)

60

40

20

0
SOF/VEL Recent ≥ Daily < Daily Recent
12 Wks Injecting at Injecting
Baseline Frequency of Injecting During Therapy
Drugs at Baseline

Grebely. Lancet Gastroenterol Hepatol. 2018;3:153. Grebely. Clin Infect Dis. 2016;63:1479. Slide credit: clinicaloptions.com
 Safety and Efficacy of GLE/PIB in PWID With Hepatitis C
Infection
 Analysis of pooled data from 8 Outcomes
Receiving OST
(n = 157)
Not receiving
OST (n = 2099)
international Phase 2 and 3 trials of Completion, n/N (%) 154/157 (98) 2070/2099 (99)
GLE/PIB; N = 2256 patients, including Adherence, n/N* (%) 121/123 (98) 1884/1905 (99)
157 (7%) receiving OST SVR12 n/N (%) 151/157 (96) 2055/2099 (98)
 GT 1 40/41 (98) 841/848 (99)
 Patients received GLE (300 mg)/PIB  GT2 17/17 (100) 443/449 (99)
 GT3 89/94 (95) 523/549 (95)
(120 mg) QD for 8, 12, or 16 wks  GT4 4/4 (100) 170/174 (98)
 GT5 0 (0) 32/32 (100)
 GT6 1/1 (100) 46/46 (98)
 Outcomes: treatment completion and
DAA-related serious AE, n (%) 0 (0) 1 (< 1)
adherence; SVR12; and safety
DAA-related AE leading to
0 (0) 5 (< 1)†
discontinuation, n (%)
 GLE/PIB demonstrated high efficacy
*Patients with missing drug accountability records not assessed for adherence
across HCV genotypes regardless of (therefore, total adherence N is lower than total patients enrolled).
†
Diarrhea; abdominal pain; dizziness; dyspepsia; fatigue; headache; malaise;
OST use nausea; pruritus; transient ischemic attack in a patient with high-risk CVD.

Grebely. Int J Drug Policy. 2019;66:73. Slide credit: clinicaloptions.com

 PREVAIL 1: Intensive Models of HCV Care for PWID
SVR by Group
 RCT at 3 opioid agonist therapy 100 94
98
programs in Bronx, New York; N = 158 90
persons with HCV GT-1 on OAT 80
‒ Injection drug use (75%)
60

SVR (%)
 Randomized groups
40
‒ Individual treatment (n = 51): self-
administer all HCV medications 20

‒ Group treatment (n = 48): attend

0
weekly treatment group Individual Group DOT
Treatment Treatment
‒ DOT (n = 51): receive observed oral
doses by nursing staff  No differences between groups in
completion rate (97% overall)
Akiyama. Ann Intern Med. 2019;170:594. Slide credit: clinicaloptions.com
 ANCHOR Study: SVR12 Rates (ITT) in PWIDs treated
With SOF/VEL
Determinants of SVR
 Prospective, open-label trial in
Yes No
Washington, DC of 100 patients 100 P = .01 P < .001
with HCV infection and opioid
use disorder with ongoing IVDU 80 91% 89%
62/68 82/92
 Treated with SOF/VEL for 12

SVR Rates (%)

60
wks and offered OAT with 63%
buprenorphine 20/32
40
 Primary endpoint = SVR12
20
 82% achieved SVR12, despite 0%
0/8
ongoing IVDU and imperfect 0
adherence OAT Use at 24 Wks Completion ≥ 2 of 3
pill bottles

Rosenthal. Clin Infect Dis. 2020;71:1715. Slide credit: clinicaloptions.com

 HERO: Hepatitis C Real Options
 Randomized trial at 25 opioid treatment programs and community health clinics in
8 US states
 Enrolled active PWIDs who have injected drugs within 12 wks of study entry;
excluded pregnancy, previous diagnosis of HCC
 Primary outcome = SVR; will follow resistance and reinfection rates for 3 yrs

Randomized participants: Modified Treatment

EOT, SVR12
 HCV GT 1-6 infection DOT (n = 376) SOF/VEL x 12 wks
Quarterly
 DAA treatment-naive
Follow-up
 HIV+, HBV+ okay Patient Navigator Treatment
 Compensated cirrhosis (n = 379) SOF/VEL x 12 wks
EOT, SVR12

Litwin. Contemp Clin Trials. 2019;87:105859. Litwin. AASLD 2020. Abstr LO10. Slide credit: clinicaloptions.com
 HERO: Initial Virologic Results
 No difference between care models: mDOT vs PN
Cascade of HCV Care
100
100 100 P = .414
80 83.6 P = .392
81.4 P = .543
Participants (%)

69.7 4.3 4.5 Did not

60 66.8
achieve SVR
54.3 56.2
40
mDOT 81.4% mDOT 82.0% mDOT 81.3%
20 PN 83.6% PN 83.3% PN 80.7%

0
mDOT PN mDOT PN mDOT PN mDOT PN
Enrolled With HCV Initiated Treatment Completed Achieved SVR
Infection With SOF/VEL Treatment
Litwin. Contemp Clin Trials. 2019;87:105859. Litwin. AASLD 2020. Abstr LO10. Slide credit: clinicaloptions.com
 MINMON: The Keep it Simple and Safe Approach to HCV
Treatment
 Single-arm, open-label, October
2018 to July 2019
 Included: treatment-naive persons
with HCV and no evidence of
decompensated cirrhosis by FIB-4
 Participants received SOF/VEL QD
for 12 wks
 Primary outcomes
‒ SVR between 22 and 76 wks post-
initiation of treatment
‒ Serious adverse events to Wk 28
Sunil. AASLD 2020. Abstr LO7.
 Patients with HCV from 38 sites in
5 countries, 400 persons (limit 132
from US) enrolled; 399 treated
‒ Median age: 47 yrs
‒ 34/399 (9%) with compensated
cirrhosis defined as FIB-4 ≥ 3.25
‒ 166 (42%) with HIV coinfection
 SVR data available for 396/399
(99%)
 355/399 (89%) self-reported taking
all medication in 12 wks
Slide credit: clinicaloptions.com
 MINMON: Minimal Monitoring Approach
 No genotyping
 All 84 tablets dispensed at outset
 No on-treatment lab visits
 Two remote contacts scheduled
‒ Wk 4: adherence assessment
‒ Wk 22: schedule SVR assessment
‒ Unplanned visits for patient concerns were permitted

Sunil. AASLD 2020. Abstr LO7. Slide credit: clinicaloptions.com

 MINMON: Baseline Characteristics and Safety Outcomes
Baseline Characteristic N = 399  Overall SAE occurrence: 3.5%
Median age, yrs (range) 47 (20-82)
(95% CI: 21-5.8)
Female sex at birth, n (%) 139 (35)

Median HCV RNA, log10 IU/mL, (IQR) 6.1

(5.6-6.6) Safety Outcomes, n (%) N = 397*
Race, n (%) At least one SAE 23 (5.8)
 White 113 (28) SAEs attributed to SOF/VEL 5 (1.3)
 Black 166 (42)  Diarrhea (n = 2)
 Asian 72 (18)  Headache (n = 1)
 Fatigue (n = 1)
History of IVDU, n (%)  Abdominal distension (n = 1)
 Current 12 (3)
 Previous 124 (31)
SAEs resulting in discontinuation 1 (0.3)
Cirrhosis (FIB-4 ≥ 3.25), n (%) 34 (9) SAEs resulting in death 0 (0)
HIV coinfection, n (%) 166 (42) *2 patients who initiated treatment were lost to follow-up.
 On ART, HIV-1 RNA < 400 copies/mL, n 164 (99)
(% of HIV+)

Sunil. AASLD 2020. Abstr LO7. Slide credit: clinicaloptions.com

 MINMON: Sustained Virologic Response
 HCV RNA available for 396/399 patients (383 collected at Wk 24)
 SVR = 95% (95% CI: 92.4-96.7)
 20 (5%) nonresponders (2 LTFU, 1 sample before window, 17 HCV RNA > LLoQ)

Participants Achieving SVR Within Study Period

No. → 379 20

%→ 0 10 20 30 40 50 60 70 80 90 100
SVR Non-SVR

Sunil. AASLD 2020. Abstr LO7. Slide credit: clinicaloptions.com

 Elimination of HCV Requires Effort on Several Fronts

HCV
Effective Test-and-treat Micro-
treatments approaches elimination
achieving considered by strategies
cure in the national and for the
majority of international hardest to
patients[1] guidelines[1,2] treat[3]

Strong interest HCV elimination

in HCV Expansion
elimination of HCV
activities treatment
across the providers[2]
globe

1. WHO. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection. Accessed
November 17, 2020. 2. Kattakuzhy. Ann Intern Med. 2017;167:311. 3. Lazarus. Semin Liver Dis. 2018;38:181. Slide credit: clinicaloptions.com
 Engagement of Non-HCV Specialists Is Critical to Close
Gaps in the Care Cascade
 Data from Jan 2013 to Dec 2016
Care Cascade by Physician Specialty*
100
19 26 21 28 20 24
33 32
Proportion of Tests (%)

80 Nonspecialist†

30 26 23 HCV specialist‡
60 28 18 23
21 20 0.6 OB/GYN
2 0.3 0.3
11 3 13 2 1 Other§
40 3 6 19 29 30 Missing specialty
17 37
20 37 38 38 28 28 25 27
15
0
Screening Detection Confirmatory Awareness Diagnosis Genotype Liver Function Treatment
test Test Test
*Percentages rounded so may add up to > 100; †Includes primary care, family practice, and internal medicine; ‡Includes
hepatologists, gastroenterologists, and infectious diseases specialists; §Includes all other physicians and specialties.

Reau. EASL 2019. Abstr PS-066. Slide credit: clinicaloptions.com

 Gaps in Diagnosis to Treatment

Generalist diagnosis: 30.96

Generalist treatment:
1.62
 Analysis of care pathway in US
95% persons with HCV from National
HCV specialist treatment: 3.88
Laboratory Database
HCV specialist diagnosis: 21.91
Other treatment:  Out of all persons diagnosed
83% 2.43
(100%) with a second positive
HCV RNA, over 89% did not
Other diagnosis: 19.17
87% Missing specialty
receive treatment
treatment: 2.58

Missing specialty diagnosis: 27.30

91% % of Diagnosed Not Being Treated, by Provider Type
OB/GYN treatment: 0.02
All Diagnoses: 100.00

OB/GYN Diagnosis: 0.66 91%

Reau. EASL 2019. Abstr PS-066. Slide credit: clinicaloptions.com
 Project ECHO: Physician Peer Support for Expanding
Access to HCV Treatment
 First developed by University of New Mexico in 2003 to build primary care
capacity to treat HCV infections in rural, underserved populations
 Video conferences link interdisciplinary specialist teams with primary care
providers for longitudinal co-management
 ECHO sessions include:
‒ Brief didactic
‒ Case presentations
‒ Discussion with community of learners
 Physician survey data demonstrated significant increases in provider
knowledge, self-efficacy, and professional satisfaction
Arora. Hepatology. 2010;52:1124. Project ECHO (Extension for Community Healthcare Outcomes). https://hsc.unm.edu/echo/. Slide credit: clinicaloptions.com
 ASCEND: PCPs Can Effectively Manage HCV Care With
Direct-Acting Antivirals
 Non-randomized, open-label trial in
SVR Rates Among Provider Types
2015 in 13 urban, FQHCs in
Washington, DC 100
89% 87% 84%
 N = 600 patients: 96% black race, 80

Response Rate (%)

69% male, 82% treatment-naive, 20
60
had cirrhosis
‒ 72% were infected with HCV 40
genotype 1a 20
‒ Treated with LDV/SOF 0
NPs PCPs Specialists
 Overall, 516 (86%) achieved SVR;
consistent across provider groups
Kattakuzhy. Ann Intern Med. 2017;167:311. Slide credit: clinicaloptions.com
Test and Treat Model for PCPs at Rush University
Medical Center
Pre-treatment: HCV Ab+ PCR– Done
 CBC, CMP (reflex PCR) PCR +, –
 FIB-4 +/-
FibroScan
 Genotype
PCR +,+  Treat HCV
HBV–, HIV–
 HBsAg Assess  Vaccinate HAV
FIB-4 < 1.45  If AUD, referral to
 HIV
 HAV-total addiction services
/HBV
Check for
Refer to specialist: SVR 4 or 12 HCV RNA– Cured
 Plts< 150 or FIB-4 >1.45
 Assess for Fibrosis
(RUQ US + FibroTest) Council re
 HIV+ Reinfectio
 HBsAg+ n
 Fail to achieve SVR
Reau. Personal Communication. Slide credit: clinicaloptions.com
Conclusions
 WHO elimination targets can only be achieved with effective screening,
diagnosis and linkage to care
 Simplified therapy requires only diagnosis, staging, DDI considerations
 Pangenotypic therapy allows simple algorithms to effectively and safely
provide treatment to large groups of individuals, with high SVR rates
‒ Studies to date show that PWIDs can be safely and effectively treated with
DAAs
 Simplified algorithms are imperative to expand the provider pool and
number of patients treated

Slide credit: clinicaloptions.com

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