Patient Navigators: an innovative approach to improve hepatitis c case finding leveraging existing human immunodeficiency virus service delivery models to reach last mile patients in Nasarawa State, Nigeria

ABSTRACT

Background and aims: The natural history of Hepatitis C Virus (HCV) demonstrates an asymptomatic disease that often leads to liver degeneration in approximately three decades. In HIV/HCV coinfection, liver degeneration is accelerated with decompensated cirrhosis occurring in less than two decades resulting in higher mortality rates. The asymptomatic nature of HCV, increased rate of disease progression in HIV, low awareness, and poor care seeking behaviour emphasizes the need to improve HCV case finding in People Living with HIV (PLHIV). In Nigeria, the Nasarawa State Government has committed to HCV elimination, with an initial focus on PLHIV, necessitating integration of services to screen ART patients for HCV. However, due to the COVID pandemic and the resultant scale-up of Differentiated Service Delivery (DSD) models within the HIV program, screening yield from facility-based case finding reduced significantly. To ensure last mile linkage to HCV screening, the Patient Navigator pilot was conducted from March-October 2021. This analysis aims to assess screening coverage before and during this pilot period. Method: One healthcare worker across three secondary facilities i.e., General Hospitals Keana, Awe, and Uke, labelled patient navigator (PN) was charged with the responsibility of identifying unscreened PLHIV using facility screening records and enrolment data. These PNs were HIV program defaulter trackers, consequently integrating this service within the HIV program. The PN employed strategic patient tracking approaches like phone calls, community engagements and peer group meetings. Using laboratory screening registers, screening progress was compared pre-intervention (July 2020 to February 2021) versus during the intervention (March to October 2021). Results: A total of 125, 560, and 923 were active on ART care as of January 2020 in General Hospitals Keana, Awe, and Uke respectively. Across sites, the first 4 months of the pre-intervention phase sawhigh screening numbers as all available patients presenting to facilities were screened. Subsequently, a decline in screening numbers across all facilities. However, the intervention phase demonstrated extended coverage, reaching the last mile patients leading to an increase in case finding by 18% in GH Keana, and 23% in GH Awe and GH Uke respectively. (Figure Presented) Conclusion: The use of patient navigators demonstrates the feasibility and cost-effectiveness of increasing case-finding through HCV/HIV program integration.