STOP HCC: Mailed HCV Treatment Outreach Program for HCC Prevention for Elevated LFTs

Study Overview
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Brief Summary
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The investigators will conduct a randomized controlled trial comparing two strategies to promote HCV screening, follow-up testing, and treatment among Parkland patients who are 18 years or older who have elevated liver functioning test (LFT) results: in reach with electronic medical record alerts and provider education vs. combination of in reach and provider education plus mailed outreach and patient navigation.

Official Title
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STOP-HCC Evidence-Based Hepatocellular Cancer Prevention Through Treatment of Hepatitis C Virus Infection

Conditions
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Hepatitis C, Hepatocellular Carcinoma

Intervention / Treatment
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* Behavioral: Mailed Outreach


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ages 18 or older elevated liver functioning tests (AST or ALT >35 that are separated by at least one month) ≥ 1 outpatient visit during 12 months prior to randomization at Parkland no prior HCV screening (prior HCV antibody, viral load, or genotype). any active medical coverage speaks Spanish or English Exclusion Criteria: a life expectancy less than one year including any history of metastatic cancer, and those who received a palliative care or hospice referral in the past year history of HCC. non-English or Spanish speakers no address or phone number on file

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Patients randomized to Group 1 will receive visit-based HCV screening, as offered by clinic providers as part of usual care. Providers must identify at-risk patients who are eligible for HCV screening, understand the benefits of screening in this population, and enter orders for HCV Ab testing. If the HCV antibody is abnormal, providers must order appropriate follow-up tests including HCV viral load to confirm HCV infection. Once HCV is confirmed, providers must refer the patients for fibrosis assessment and treatment evaluation. These efforts are augmented by an established best practice alert and health maintenance reminders. | |
| Active Comparator: Mailed Outreach<br>Patients randomized to Group 2 will receive low literacy, written materials about HCV screening in English and Spanish. The invitation will include patient-centered educational materials that discuss the risk of HCV in patients with elevated LFTs and the benefits and risks of HCV screening. The invitation will include a phone number to schedule the HCV antibody test. Once a potential subject is identified and randomized in Group 2, an outreach invitation will be mailed out. Shortly after the letter, a bilingual patient navigator will call to this potential subject. Patients will also receive centralized patient navigation to facilitate screening completion and appropriate test follow-up. He/she will help patients schedule HCV antibody testing and will assume responsibility for tracking results. Patients referred to the Hepatitis C clinic for treatment evaluation will receive reminder calls from trained and credentialed study staff 5-7 business days for scheduled appointments. | Behavioral: Mailed Outreach<br>* The investigators will randomize elevated LFT patients ( 12,000 patients) using a centrally maintained computer-generated list. Patients will be randomly assigned to one of two HCV screening strategies including: visit-based screening as part of usual care (Group 1) or mailed screening invitation outreach and centralized patient navigation (Group 2).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hepatitis C Screening | Proportion with HCV Ab or HCV VL within 6 months of randomization | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hepatitis C Screening | Proportion with HCV Ab within 12 months of randomization | 12 months | 
| Hepatitis C Confirmation | Proportion with HCV Viral Load within 3 months of positive antibody result | 3 months | 
| Hepatitis C Linkage to Care | Proportion with clinic visit within 6 months of positive HCV Viral Load | 6 months | 
| Cost Per Patient Screened | The primary measure of costs will be the cost per Ab completion. | 3 months | 
| Cost Per HCV Diagnosis | The primary measure of costs will be the cost per-patient diagnosed with HCV. | 12 months |