Northern California hepatitis C elimination project: Tele-mentoring led to quick adoption of hepatitis C treatment

ABSTRACT

Background: Hepatitis C virus (HCV) remains a major public health crisis in rural communities across Northern California Successful detection and linkage-to-care continues to face significant challenges especially with the lack of 'treaters' in these communities A targeted approach to primary care provider (PCP) education in rural communities utilizing telementoring was developed as part of a multifaceted initiative to increase provider capacity within Northern California (called ECHO-PLUS) The primary intent was to cultivate local HCV treatment champions, providing patients access to timely care Methods: Tele-mentoring using a telemedicine-based approach with provider and patient both in the exam room at the PCP 'mentee' site, and an HCV specialist and specialty pharmacist at the mentor site. Prior to the first patient encounter, mentees received 1-hour CME-certified HCVfocused education Subsequently, patients were scheduled for clinic times with new visits lasting 30 minutes and follow-ups lasting 15 minutes There was additional 5-10 minutes pre/ post visit discussion between mentor and mentee related to management of the patient's hepatitis C A provider readiness survey was done independently by the specialist and pharmacist on a Likert-type scale with three questions (scored 1-5, total score 15) following each patient visit Results: A total of 19 providers from 14 discrete clinics located in 14 counties spread over Northern California and Central Valley participated 11 of the 19 providers saw at least one HCV patient with a mentor;the other 8 providers only attended the CME-based HCV education Of the 11 participating providers, 5 classified themselves as 'experienced' having treated previously with PEG-interferon and 6 as 'inexperienced' or never-treated HCV A total of 60 hours of tele-mentoring sessions were completed with 31 patients treated jointly, all of whom successfully underwent HCV treatment Inexperienced treaters saw at least 3 patients and a maximum of 6 patients, while experienced treaters saw 1-2 patients Experienced treaters had 1 5-3 hours of tele-mentoring compared to 3-7 hours for inexperienced treaters Provider readiness surveys showed a median improvement by 7-points with a final score of 13 5 versus starting score of 6 5, with inexperienced treaters showing the greatest change Within a month of tele-mentoring completion defined by their readiness survey, the prior inexperienced treaters noted treating 2-5 patients independently Conclusion: Individualized tele-mentoring led to early adoption of HCV therapy ECHO programs combining various modalities of telemedicine can help successfully create 'champion' providers in rural and underserved communities providing essential care that becomes especially relevant with the surge of SARS-CoV-2.