Provision of hepatitis c care in a federally qualified health center during the COVID-19 pandemic and beyond

Background: In response to the challenges of providing Hepatitis C care during the COVID-19 pandemic, the Hepatitis C program at Philadelphia FIGHT Community Health Centers, a Federally Qualified Health Center, transitioned to a modified patient centered model of hepatitis C (HCV) care and social service provision in March of 2020. Methods: Beginning on March 15, 2020, the HCV program initiated a modified approach to providing HCV care for patients. Interventions included telemedicine for initial evaluation and medication adherence support, outreach for medication delivery, mobile phlebotomy, and collaboration with treatment facilities. Patients were referred from substance use treatment programs, the Philadelphia Department of Prisons, and self-referral for primary care. A weekly multidisciplinary team huddle was among the clinical team. Herein, we report the experience of our program during the first year. Results: Between March 15, 2020 and March 14, 2021, 148 patients were engaged in HCV services and 134 (90%) patients initiated treatment. Among our HCV patients, 11 (7%) patients were born between 1945 and 1965, 97 (66%) patients were born between 1966 and 1985, and 40 (27%) were born after 1985. 99 (67%) identify as male and 49 (33%) identify as female. Twenty-three (16%) patients identify as Black or African American, 114 (77%) identify as White, and 11 (7%) declined to specify. 19 (13%) identify as Hispanic or Latino. Eighty-five (57%) patients received only telemedicine services, 53 (36%) patients received a hybrid of telemedicine and in-person services, and 11 (7%) received medical services exclusively in-person in the health center. Of the patients who initiated treatment, 90% received HCV medication delivered to their homes or inpatient and outpatient substance use treatment programs. Thirty patients (22%) have achieved SVR. Conclusion: The COVID-19 pandemic has forced changes in the approach to the management of chronic HCV infection, particularly for patients with a history of substance use disorder. In our FQHC, a creative team approach utilizing telemedicine and medication delivery to patients enabled us to initiate and complete HCV treatment without the requirement for in office visits. Maintenance and expansion of services developed during the COVID pandemic will lead to a focus on increasing HCV treatment for patients in substance use treatment programs and increased rates of SVR confirmation.