Hepatitis C Micro-elimination Using Patient Navigation In a Regional Healthcare System

<h3>Context:</h3> Hepatitis C virus (HCV) disproportionately impacts persons with substance use and mental health disorders within the United States. Micro-elimination projects aim to selectively foster diagnosis, treatment and reinfection of high priority demographic groups. A small-scale, peer navigation focused micro-elimination project was launched to facilitate treatment engagement and re-testing for individuals experiencing elevated risk of HCV re-infection. <h3>Objective(s):</h3> This research explores patient navigation between primary care and specialty care to facilitate treatment completion in a health care system. <h3>Study Design / Analysis:</h3> Prospect cohort study with descriptive statistics calculated within groups and for the entire cohort. Univariate statistics and multivariate regression statistics were calculated. <h3>Setting:</h3> MedStar Health, a multidisciplinary and multispecialty health care system in the mid-Atlantic. <h3>Population Studied:</h3> Individuals identified through electronic medical record (EMR) periodic surveillance with either diagnosed with HCV and either not engaged in treatment or not completed treatment, as well as those needing additional testing (SVR or high-risk re-testing). A particular focus was those falling outside of the traditional birth cohort. <h3>Intervention:</h3> Patient navigation program to specialist treatment from primary care with additional referral to behavioral health services. <h3>Results:</h3> Between April 2022 and July 2023, 116 persons navigated through the program, including 78 persons without a prior specialist appointment (New Patients), 15 persons previously engaged with a specialist but not completed treatment. Among new patients, 58.9% were female, 74.4% identified as Black, 79.5% were on Medicaid insurance when diagnosed. Among New Patients, 44.8% of patients attended appointments, 19.2% started treatment, and 10.2% had a confirmed undetectable HCV RNA test. People starting treatment were significantly older (aOR: 4.43, p=0.033). Patients with prior engagement with specialists were more likely to complete treatment. <h3>Conclusions:</h3> A small-scale, peer-navigation focused micro-navigation program successfully engaged patients but had mixed success in navigating the care cascade. Despite navigation and consistent engagement, nearly half of patients dropped off at each step of the care cascade. Future efforts should be targeted at reducing times for specialist and expanding HCV treatment in primary care.