Nurse Case Management to Improve Hepatitis C Linkage to Care and Treatment in HIV Coinfection

Johns Hopkins University, Baltimore MD

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Abstract

? DESCRIPTION (provided by applicant): Coinfection with HIV and hepatitis C virus (HCV) results in a three-fold increase in progression to end stage liver disease and cirrhosis compared to HCV alone. Although curative treatments exist, less than one quarter of people with HCV are linked to care and even fewer have received treatment. The proposed study is a single-blinded, randomized controlled trial to improve the HCV treatment cascade among people coinfected with HIV. This study will test whether a nurse case management intervention can 1) improve linkage to HCV care and 2) decrease time to HCV treatment initiation among people coinfected with HIV. Participants will be recruited from an urban HIV clinic that serves a primarily low income African American population with 50% of patients coinfected with HIV/HCV. Barriers to HCV linkage and treatment among people with HIV include low knowledge, competing demands, and HIV/HCV drug interactions, which can be addressed with nurse case management. The nurse case management intervention will be conducted in two phases. The first phase includes nurse-initiated referral, strengths-based HCV education, patient navigation, and appointment reminders. The second phase includes care coordination of antiretroviral modifications to minimize the impact of HIV/HCV drug interactions. The intervention components are guided by the Andersen Behavioral Model of Health Services Use, which will be used to explain why participants engage or do not engage in HCV care. The findings from this study will ensure that the most effective linkage to care and treatment approach is integrated into care of this population. This study supports the President's Care Continuum and Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, as well as the latest Guidelines for Use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents. This study's purpose is directly aligned with the NINR's strategic plan to improve health in minority and underserved populations through evidence-based interventions that promote wellness and self-management.