2006 Model Practice Application (Public)

FL Hep-CARE Project (Florida Hepatitis Collaboration, Assessment, Resources, and Education)

Alachua County Health Department

The goal of the program was to provide Hepatitis C treatment to low income patients. The target population of the FL Hep-CARE Project consists of low income adults with chronic Hepatitis C. Out of 328 patients who were screened positive, 40 were eligible for the Hep-CARE clinic. Others did not meet financial or medical criteria. The objectives are to: 1) enroll as many eligible candidates as possible in the FL Hep-CARE project; 2) achieve sustained viral response in a percentage of the enrolled patients which is comparable to the success rate in traditional practices; and 3) be a model for other local hepatitis treatment programs.

As of February 16, 2006 40 patients have been scheduled for the liver care clinic at the Alachua County Health Department. Twenty four have kept their appointment in the clinic. Thirteen have started treatment. One has completed treatment (which takes 6 to 12 months to complete depending on the genotype). At this time seven are still on treatment.

Public Health Issue- Lack of access to hepatitis C treatment for the low income population. Through the hepatitis testing program and epidemiological reporting it was determined there was no place for low income hepatitis C adults to receive treatment. This practice model provides the needed treatment. The local health department already has an established hepatitis testing and vaccination program. From this program those with hepatitis C positive results can be referred to the treatment clinic.

Very few programs provide actual treatment for hepatitis C within a local county health department. No other LHD in Florida provides this at this time. This practice provides tertiary care for low income patients who would not otherwise have access to this specialty treatment. The only other options for the low income in the past have been to enroll in clinical trials as they become available.

The LHD was instrumental in developing this program by bringing together health care professionals, pharmaceutical companies, and people living with hepatitis C. The state Hepatitis Program provided leadership in this collaboration of private and public partnerships.

Beginning one year before the first clinic was held, community partners including State and local Department of Health personnel and University of Florida, College of Medicine faculty met to discuss the possibility of initiating a clinic for low income patients with hepatitis C. This clinic would be situated in the local health department. The health department personnel would be trained by the University of Florida faculty with the plan that, once trained, health department staff could provide this specialty care. The University of Florida faculty would continue to provide consultation regarding medical management as needed. Patients seen in this clinic would be generated from the Florida DOH Hepatitis testing program (which began in 2001) and from the local health department primary care program. In addition referrals from other agencies would be accepted. To be financially eligible patients must be under 100% of the Federal Poverty Guidelines.

In January 2005 further meetings were held to work out the details and provide education to the health department staff in the form of a presentation by the faculty from UF. The first clinic was held just prior to the Florida Hepatitis Awareness day in Tallahassee (2005) and Dr. David Nelson, from the University, announced the start of the project. Ongoing training is also provided by the pharmaceutical companies who also provide medication through their patient assistance programs.

The clinic is held one morning a month at the local health department. Patients on treatment report every month to clinic while on treatment. Only 12 appointments are available once a month. Current treatment consists of weekly interferon shots and daily oral ribavirin.

By showing success in treatment, the commitment to continuing this program will be reinforced. It is hoped that by obtaining desired results with the initial funding of $50,000 for one year, additional funding will be forthcoming in the future. Also, the possibility of more effective treatments becoming available in the future justifies maintaining the infrastructure and client base for future treatment. Presenting this model program at seminars, meetings and to the legislature are considerations for sustaining funding for this and similar projects in other LHD’s. Treating Hepatitis C now at a cost of less than $40,000 a year saves the later cost of a liver transplant at $240,000 to $350,000, not to mention hospitalizations and quality of life. The latter is a cost of 6-9 times the cost to treat now. Although HIV/AIDS treatment is ongoing, hepatitis treatment only lasts 6-12 months and the percentage of a sustained viral response (cure) is increasing each year.

Goal: Provide Hepatitis C treatment to low income patients.

Objective: Of patients who complete treatment, achieve a sustained virilogical response (SVR) comparable to the other practices:

• Performance measures: Major clinical trials have demonstrated >50% SVR's in 48 weeks of combination therapy.
  
  
• Data collection: The lab collects the viral load at specified intervals to measure the viral response.
  
  
• Outcomes: The program has only been in existence 12 months so cannot evaluate util 18 months have past.

Objective: Enroll as many eligible patients as possible in the FL Hep-CARE project:

• Performance measures: Enroll 50% of the target population.
  
  
• Data collection: Data collected by the LHD and case manager on number of patients enrolled into project.
  
  
• Outcomes: Intended outcome has not been evaluated.

Objective: Provide Hepatitis C treatment to low income patients:

• Performance measures: Provide treatment to 80% of patients who qualify.
  
  
• Data collection: Data collected by nurse case manager on number of patients who qualify for treatment.
  
  
• Outcomes: Intended outcome has not been evaluated.