studies

1086A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Disclosures:
Stuart C. Gordon - Advisory Committees or Review Panels: Janssen; Consulting:
Merck, Gilead, BMS, CVS Caremark, Amgen, AbbVie; Grant/Research Support:
Merck, Gilead, AbbVie, Intercept Pharmaceuticals, Exalenz Sciences, Inc., BMS
The following authors have nothing to disclose: Fujie Xu, Jian Xing, Anne C.
Moorman, Loralee B. Rupp, Mei Lu, Philip R. Spradling, Eyasu H. Teshale, Joseph
A. Boscarino, Mark A. Schmidt, Connie M. Trinacty, Scott D. Holmberg
1801
From Care to a Cure: Improving the Hepatitis C Care
Cascade through Patient Navigation in the Check Hep C
Program in New York City
Mary Ford, Nirah Johnson, Payal Desai, Eric J. Rude, Fabienne
Laraque; New York City Department of Health and Mental
Hygiene, New York, NY
Background: Of the estimated 146,500 persons with hepatitis
C (HCV) infection in New York City (NYC), only about 10% are
thought to have ever received treatment. New, highly effective
HCV treatments provide an impetus for increased public health
efforts to support HCV-infected persons along the care cascade
from diagnosis to cure. Check Hep C, a program of the NYC
Department of Health and Mental Hygiene (DOHMH), provided
HCV screening, navigation, and tele-medicine in Year 1.
Over 4,000 persons were tested, and 512 were RNA positive.
Of those, 435 (85%) were linked to care, 14 initiated treatment
and 3 had a sustained virological response (SVR). The small
number of patients treated and cured highlighted the need
for intensified patient navigation services through treatment.
Methods: In Year 2, navigation services were provided at four
sites following a standardized protocol. Services included a
comprehensive social and health assessment, appointment
assistance, support for medical evaluation and treatment, and
pharmacy coordination. Patient navigators worked to enroll a
target of 400 participants and form strong relationships with
the multidisciplinary team involved in each patient’s care. Program
data were entered in a standard database by the patient
navigators and sent to DOHMH. Descriptive analysis was conducted.
Results: Between March 2014 and January 2015, 388
(97% of the target) participants were enrolled in Check Hep C.
The median age of participants was 52 years, and 236 (61%)
were born between 1945-1965. Of 376 participants with
race/ethnicity data, 242 (64%) were Hispanic and 103 (27%)
were Black, non-Hispanic. Of 364 participants with risk history
data, 182 (50%) had current chemical dependence, 108
(30%) had a history of intravenous drug use, and 91 (25%)
were homeless. As of April 2015, 308 (79%) participants
received HCV medical care, and 301 (78%) completed an
HCV medical evaluation, of which 232 (77%) were treatment
candidates. Of the treatment candidates, 116 (50%) initiated
treatment, and 86 (74%) of those completed treatment. Thus
far, 70 participants (81% of those who completed treatment)
achieved SVR. Conclusion: The Check Hep C program successfully
assisted high-need participants through HCV care and
treatment, including those with active chemical dependence
and homelessness, helping a much higher number of patients
in achieving SVR in Year 2. Programs such as this community-based
patient navigation intervention can help improve the
HCV care cascade, particularly for high-need persons. Sustainable
sources of funding, including insurance reimbursement,
need to be provided to support these critical services.
Disclosures:
Eric J. Rude - Grant/Research Support: Vertex, Merck, Bristol Myers Squibb,
Orasure, Janssen, Gilead, Kadmon, Boehringer-Ingelheim, Abbott, Genentech
The following authors have nothing to disclose: Mary Ford, Nirah Johnson, Payal
Desai, Fabienne Laraque
1802
Treatment prioritization according to the EASL HCV CPG
2015: a real-life evaluation on the PITER (Piattaforma
Italiana per lo studio della Terapia delle Epatiti viRali)
cohort
Loreta A. Kondili 1 , Stefano Rosato 2 , Maria Giovanna Quaranta 1 ,
Liliana E. Weimer 1 , Loredana Falzano 1 , Alessandra Mallano 1 ,
Maria Elena Tosti 2 , Maurizio Massella 1 , Maurizia R. Brunetto 3 ,
Anna Linda Zignego 4 , Mario Rizzetto 5 , Alfredo Di Leo 6 , Giovanni
Raimondo 7 , Carlo Ferrari 8 , Gloria Taliani 9 , Pierluigi Blanc 28 , Antonio
Gasbarrini 10 , Luchino Chessa 11 , Elke M. Erne 12 , Giovanna Fattovich
13 , Pietro Andreone 14 , Maria Vinci 15 , Francesco P. Russo 16 ,
Erica Villa 17 , Giovanni B. Gaeta 18 , Teresa A. Santantonio 19 , Guglielmo
Borgia 20 , Gabriella Verucchi 21 , Carmine Coppola 22 , Marcello
Persico 23 , Liliana Chemello 29 , Alfredo Alberti 16 , Vincenzo De
Maria 30 , Massimo Puoti 31 , Raffaele Bruno 24 , Paolo Caraceni 14 ,
Massimo Andreoni 25 , Marco Marzioni 26 , Stefano Vella 1 , Antonio
Craxi 27 ; 1 Therapeutic Research and Medicines Evaluation,
Istituto Superiore di Sanità, Rome, Italy; 2 Istituto Superiore di Sanità,
Rome, Italy; 3 Azienda Ospedaliero-Universitaria Pisana, Pisa,
Italy; 4 University of Florence, Florence, Italy; 5 University of Torino,
Torino, Italy; 6 University of Bari, Bari, Italy; 7 University Hospital of
Messina, Messina, Italy; 8 Azienda Ospedaliero- Universitaria di
Parma, Parma, Italy; 9 Sapienza University of Rome, Rome, Italy;
10 Policlinico Universitario Agostino Gemelli, Rome, Italy; 11 University
of Cagliari, Cagliari, Italy; 12 Azienda Ospedaliera Padova,
Padova, Italy; 13 University of Verona, Verona, Italy; 14 University
of Bologna, Bologna, Italy; 15 Niguarda Hospital, Milan, Italy;
16 Azienda Ospedaliero-Universitario Padova, Padova, Italy; 17 University
of Modena and Reggio Emilia, Modena, Italy; 18 Second
University of Naples, Naples, Italy; 19 University of Foggia, Foggia,
Italy; 20 Federico II University of Naples, Naples, Italy; 21 Sant’Orsola
Malpighi Hospital of Bologna, Bolgna, Italy; 22 Gragnano
Hospital, Naples, Italy; 23 University of Salerno, Salerno, Italy;
24 University of Pavia, Pavia, Italy; 25 Tor Vergata University,
Roma, Italy; 26 Università Politecnica delle Marche, Ancona, Italy;
27 University of Palermo, Palermo, Italy; 28 Santa Maria Annunziata
Hospital, Florence, Italy; 29 University of Padua, Padua, Italy;
30 Azienda Ospedaliero-Universitaria Mater Domini, Catanzaro,
Italy; 31 Azienda Ospedaliera Niguarda-Cà Granda, Milano, Italy
Aim. The high cost of DAAs for chronic hepatitis C has generated
allocation policies mostly based on fibrosis staging as
a surrogate for treatment needs. The EASL HCV CPG 2015
indicates treatment allocation: treatment prioritized as first line,
treatment justified as second line then deferred and not recommended
treatment. We assessed the impact of this approach
on a real-life cohort of 6831 consecutive patients presenting
for care at 80 Italian Units, collected over the last 12 months
within the PITER framework. Methods. The EASL CPG treatment
prioritization algorithm considers fibrosis stage, HIV or HBV
coinfection, pre and post transplant setting, extra-hepatic manifestations,
i.v. drug use, hemodialysis. The independent effect
of each of these factors and of major comorbidities (cardiovascular,
metabolic, autoimmune/reumatological, neurological/psychiatric,
neoplastic severe diseases) in patients older
than 75 years, was evaluated by multivariate analysis. Results.
Median age of the 6831 patients was 58 years (range 20-95
yrs); 3797 (56%) were male. Matching of patients with the
EASL CPG treatment indications resulted being categorized as
follow: prioritized: 739 (11%) patients with F3 fibrosis; 1846
(27%) patients with F4 fibrosis/Child A cirrhosis; 723 (11%)
patients with Child B/C cirrhosis of whom 340 (5%) patients
with HCC; 173 (3%) women of childbearing age; 280 (0.4%)
drug users; 397 (6%) HIV or HBV coinfected patients; 587
(9%) patients with severe extra-hepatic manifestations; 52 (1%)
patients in LT waiting list; 84 (1%) patients with post LT HCV