Nurse case management to improve the hepatitis C care continuum in HIV co‐infection: Results of a randomized controlled trial
Year: 2019
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: The opportunity to eliminate hepatitis C virus (HCV) is at hand, but challenges remain that negatively influence progress through the care continuum, particularly for persons co-infected with HIV who are not well engaged in care. We conducted a randomized controlled trial to test the effect of nurse case management (NCM) on the HCV continuum among adults co-infected with HIV compared to usual care (UC). Primary outcomes included linkage to HCV care (attendance at an HCV practice appointment within 60 days) and time to direct-acting antiviral (DAA) initiation (censored at 6 months). Sixty-eight participants were enrolled (NCM n = 35; UC n = 33). Participants were 81% Black/African American, 85% received Medicaid, 46% reported illicit drug use, 41% alcohol use, and 43% had an undetectable HIV viral load. At day 60, 47% of NCM participants linked to HCV care compared to 25% of UC participants (P = .031; 95% confidence bound for difference, 3.2%-40.9%). Few participants initiated DAAs (12% NCM; 25% UC). There was no significant difference in mean time to treatment initiation (NCM = 86 days; UC = 110 days; P = .192). Engagement in HCV care across the continuum was associated with drinking alcohol, knowing someone who cured HCV and having a higher CD4 cell count (P < .05). Our results support provision of NCM as a successful strategy to link persons co-infected with HIV to HCV care, but interventions should persist beyond linkage to care. Capitalizing on social networks, treatment pathways for patients who drink alcohol, and integrated substance use services may help improve the HCV care continuum.
Source: Journal of Viral Hepatitis
DOI: 10.1111/jvh.13241
Institutions: Johns Hopkins University, Columbia University
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1044130170, G2456272280, Nurse Case Management to Improve Hepatitis C Linkage to Care and Treatment in HIV Coinfection, G6302187890, G8142833747, Systems Science and Comparative and Cost-Effectiveness Research Training for Nurse Scientists (S2CER2), The Johns Hopkins Center for AIDS Research (JHU CFAR), Yale Clinical and Translational Science Award
OpenAlex ID: W2946117464