ABSTRACT
To the editor: In the United States (US), an estimated 2.4 million persons have chronic infection with hepatitis C virus (HCV). The number of deaths from HCV-related mortality is greater than that of HIV and tuberculosis combined. Treatment with direct-acting antivirals (DAAs), usually 1-3 pills a day for 8 or 12 weeks, can cure over 95% of patients. Successful treatment of HCV has been shown to greatly reduce liver-related as well as all-cause mortality. American Indian and Alaska Native (AI/AN) people have over twice the national rate of HCV-related mortality. The largest health care provider for AI/AN communities is the Indian Health System, a national network of federal (Indian Health Service), tribal, and urban health facilities, comprised mostly of rural primary care clinics. As part of the Indian Health System response to HCV, health facilities have access to tele-mentoring support such as the ECHO (Extension for Community Healthcare Outcomes) model, which has demonstrated excellent outcomes in treating HCV. The program connects rural clinicians (‘spokes’) to a specialist team (‘hub’). These participants meet regularly via low-bandwidth video conference technology. The format of case-based learning, supported by short didactic presentations, aims to scale up clinical capacity across a health network. Patient presentations entail a brief de-identified standardized form with a patient’s clinical history to assess liver disease severity and determine optimal HCV treatment. [...]