A Hepatitis C Treatment Program Based in a Safety-Net Hospital Patient-Centered Medical Home

I was pleased to see "A Hepatitis C Treatment Program Based in a Safety-Net Hospital Patient-Centered Medical Home" by Dr. Lasser and colleagues published in Annals of Family Medicine. The paper describes a public health oriented program that uses a multidisciplinary team, including general internists, to provide HCV care and treatment for patients in an urban patient centered medical home. The program demonstrated success in navigating patients through a complex care cascade and revealed 100% cure rates with antiviral therapy.

Exploring novel and patient-centered alternative models to traditional HCV care is particularly salient in 2017. With the new era of all-oral, easy to tolerate, short course direct acting antiviral therapy for HCV firmly upon us, we need to adapt treatment models accordingly. We have a new paradigm for antivirals, and we need a new paradigm for HCV models of care.

Dr. Lasser's program highlights some key features that are integral to the success of these new models. First, taking a public health perspective is crucial. We have the opportunity to eliminate HCV, and critical to this is employing population management strategies. We have excellent cure rates for patients who make it to the final stages of the care cascade, but identifying infected patients guiding them through the cascade stages that precede treatment remains challenging. Perhaps HCV programs based in primary care and led by generalists, ideally with input from colleagues in public health, are the ideal venues in which to embark on small scale elimination programs.

Second, similar to Dr. Lasser, we have found that multidisciplinary teams are integral to a successful HCV program. Our primary care-based HCV treatment program at Grady Memorial Hospital relies on clinical pharmacists, pharmacy techs and patient navigators working in concert with general internists to achieve successful treatment outcomes.

Finally, it is important that Dr. Lasser and team highlighted the contribution of the 340b drug discount program to the success of their HCV treatment program. One of the main concerns voiced by those considering launching programs to expand HCV care is how to fund them. This paper provides a great example of successfully leveraging revenue generated from the 340b program to invest into the HCV program. This is the model we use and one that can be easily replicated at other sites that participate in the 340b program.

I hope we will be seeing increasing reports of programs like Dr. Lasser's that demonstrate the success of primary care-based, generalist- run HCV treatment. We have the antiviral treatment tools we need to eliminate HCV; now we need to demonstrate equal success with screening and access to care and treatment.

Competing interests: None declared