The impact of COVID-19 on an outpatient HCV testing and treatment program in New York City: A natural experiment in sudden HCV treatment simplification

ABSTRACT

Background: Some have advocated for hepatitis C virus (HCV) treatment simplification through reduced treatment monitoring, utilization of telehealth, and task-shifting The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital in New York City provides HCV treatment services for people who use drugs through a harm reduction primary care model COVID-19 created unique barriers such as the sudden closure of REACH's outpatient practice mid-March 2020 and the reassignment of medical providers to inpatient COVID-19- related tasks In response to these barriers, REACH began utilizing telehealth for HCV treatment encounters and shifted toward a nurse-driven treatment-monitoring model We aimed to assess how this natural experiment in sudden treatment simplification affected REACH's ability to engage with and treat people who use drugs and are living with HCV during the COVID-19 pandemic Methods: Data was collected between March 20 and July 6, 2020 In place of in-person visits, telehealth visits were conducted over the phone or through video visits We were able to provide free cell phones with unlimited data plans to all patients who were not able to access telehealth visits due to lack of a phone or data plan A program RN monitored all active HCV-infected patients, reaching out to them by phone to discuss medication adherence and monitor side effects Notes from these encounters were then routed to the medical provider for review and to determine if follow-up from a physician was needed Results: During this 15-week period, REACH engaged twelve new HCV-infected patients and maintained engagement via telemedicine with thirteen additional patients already in the treatment work-up process Sixteen patients started treatment during this period, three of whom had entirely telehealth psychosocial (administration of PREP-C by social worker;prepc org) and medical work-up processes Of the ten patients on treatment at the beginning of this period, there was a treatment completion rate of 80% compared to REACH's pre-COVID treatment rate of 92% Of the eight patients who completed treatment, seven have completed end of treatment HCV RNA labs, all of which were undetectable In total, the program RN followed up with thirtyfour separate HCV-infected patients in fifty-five encounters. Conclusion: COVID-19 dramatically affected REACH's model of HCV care, forcing us toward sudden treatment simplification. Our rapid transition allowed us to provide uninterrupted care during the public health crisis We are now revising our existing HCV care model to systematically incorporate telemedicine, nurse-driven treatment-monitoring, and streamlined patient visit and lab schedules, thereby establishing a hybrid model of telehealth/in-person HCV care to best serve the needs of our patients in the context of ongoing limited in-person visits due to COVID-19.