State Combats Hepatitis with Training

Heidi Swygard, MD, MPH

Heidi Swygard, MD, MPH

In North Carolina, acute hepatitis C virus (HCV) has increased 400 percent since 2009. There are an estimated 110,000 people living with chronic HCV in the state.

“The increases we have seen are a direct consequence of the opioid epidemic and substantial increases in injecting drug use. We are working with providers to identify and screen patients at risk and report acute cases to the state,” says Heidi Swygard, MD, MPH, an associate professor of medicine in the Division of Infectious Diseases at the University of North Carolina School of Medicine, and the viral hepatitis medical director in the NC Division of Public Health’s Communicable Disease Branch.

HCV causes inflammation in the liver, which can lead to scar tissue and prevent the liver from working normally. If left untreated, fibrosis, cirrhosis and liver failure can occur. There is a cure for HCV, but only those diagnosed with the virus can be connected to treatment.

Since primary care providers are often the first line of defense for diagnosis, especially in rural areas of the state, an innovative training program for these clinicians has been launched. The Carolina Hepatitis Academic Mentorship Program (CHAMP) officially got underway in January. The NC Division of Public Health, the UNC School of Medicine and Duke University Medical Center worked together to develop this telemedicine training program. The model embraces the vision to increase access to specialty care beyond the urban setting by linking primary care providers in difficult to reach locations to academic mentors for disease-specific training.

“The objective of CHAMP is to expand access for persons infected with hepatitis C virus by embracing a training approach designed to remove barriers to care,” says Kimberly Psaltis MPH, RN, CDE, who oversees the program for the Communicable Disease Branch in the NC Division of Public Health. “Our intention is to build a North Carolina primary care workforce trained to diagnose, care for and cure persons infected with hepatitis C.”

CHAMP provides an opportunity to train primary providers to diagnose and deliver hepatitis C curative therapies as well as link those patients with more complicated needs to specialists at a tertiary center. To achieve this goal, the NC Division of Public Health approached leading experts at UNC and Duke to develop a peer training program for primary care providers to manage hepatitis C care and work towards eliminating the disease statewide.

“What I like about this program is that it is flexible, scalable and sustainable,” says Swygard. “It is an opportunity for providers to gain experience under the umbrella of academic expertise and deliver quality care to their patients in their communities.”

Hepatitis C virus is curable. If left untreated, it can damage the liver.

Hepatitis C virus is curable. If left untreated, it can damage the liver.

Clinicians begin the CHAMP process with an intensive, in-person boot camp to learn about hepatitis C diagnosis and treatment. Afterwards, those who enroll will meet by teleconference in small groups for approximately one hour every other week. During that time, they have the opportunity to present cases to their peers and mentor for review and feedback. Academic mentors are also available for additional consultations and as backup to manage more advanced or complex situations better suited for tertiary care. By establishing strong referral networks, patients with advanced liver disease can be linked to a specialist to manage monitoring for liver-related complications of hepatitis C, including hepatocellular carcinoma. The expectation for providers who attend boot camp and enroll in CHAMP will be to start implementing screening guidelines for hepatitis C in their clinical practice and begin delivering new curative therapies and reduce the burden of chronic disease care.

CHAMP builds upon a successful mentorship initiative led by Michael Fried, MD, director of the UNC Liver Center. Two years ago, Fried began consultations about hepatitis C care with Rick Moore, MD, and Alison Bartel, MD, of the Rural Health Group in Roanoke Rapids, NC. The remote training began with twice-monthly teleconferencing consultations about hepatitis C care.

In its first 18 months, that effort produced extremely encouraging results in the treatment and cure of patients with hepatitis C.

“Dr. Moore and Dr. Bartel were very dedicated to treating hepatitis C and that was reflected in the outstanding care that they provided to their patients,” says Fried. “They demonstrated that this collaborative model could be highly effective to help deal with the growing burden of hepatitis C in North Carolina, especially in areas where there was limited access to specialty care.”