Evaluations of the ADAP Program for HCV Treatment
Creators: name: Ives-Louter, Katie
Publisher: name: DigitalHub. Galter Health Sciences Library & Learning Center
Year: 2020
Subjects: subject: Hepatitis C
subject: HIV
subject: public health
subject: AIDS drug assistance program
subject: Hepatitis C
subject: HIV
subject: Delivery of Health Care
subject: Illinois Territory

description: Background: Hepatitis C (HCV) is a viral infection that causes severe liver disease, including hepatocellular carcinoma and cirrhosis. Among people living with HIV, there are high rates of co-infection with HCV, particularly among people who inject drugs. While highly effective HCV medications have been developed in the past decade, they remain extremely expensive and their approval by insurance companies and Illinois Medicaid is often contingent on a patients degree of liver damage, making them largely inaccessible for many patients. In 2016, the AIDS Drug Assistance Program, funded by the Illinois Department of Public Health, added HCV medications to their formulary, allowing low-income patients who are co-infected with HIV and HCV to access HCV treatment. This study aimed to evaluate the ADAP HCV Treatment Program for barriers faced by patients and providers to utilizing the program, as well as treatment outcomes for enrollees.Methods: This study utilized both qualitative and quantitative methodologies. First, a semi-structured interview and focus group of providers and care teams were conducted at the two treatment facilities that treated the largest number of enrollees. Participants were asked specifically about perceived barriers that patients faced to participating in the program, as well as challenges experienced by providers and care teams in treating patients enrolled in the program. To determine treatment outcomes of enrollees, reported laboratory data was used to determine rates of follow-up for all enrollees and rates of sustained virologic response (SVR) for all patients who had adequate follow-up. These rates were then analyzed for differences in treatment facility volume, transmission risk factor, age cohort, and race/ethnicity using chi-square tests.Results: The interview and focus group provided insights into the experiences of program participants. Specifically, enrollees often faced barriers including providing documentation to enroll in ADAP and handing competing priorities such as housing and transportation. Care teams found that some aspects of enrolling and treating patients through the program were time- and personnel-intensive and required a high degree of care management, and they suggested specific changes that might make working with the program easier. The outcomes data showed that the two highest-volume treatment facilities had better rates of follow-up than low-volume facilities, X2(1, N = 111) = 5.56, p = 0.018. However, there was no difference in rates of SVR between the two facility types among those patients who did receive adequate follow-up, X2 (1, N = 78) = 0.18, p = 0.67. There was no difference in rates of follow-up or SVR when analyzed by transmission risk factor, age, or race/ethnicity.Conclusions: Major barriers to patient enrollment and retention can be addressed by intensive care management through treatment facilities. However, this requires numerous, dedicates care management personnel and is time-intensive. High-volume treatment facilities have higher rates of patient follow-up, possibly because they have more auxiliary support staff dedicated to care management. Across both high- and low-volume facilities, and all patient demographics, there is no difference in treatment outcomes among patients who receive adequate follow-up. Therefore, treatment programs and facilities should continue to support and expand care management services in addition to medical therapies to achieve the best treatment outcomes.