Task shifting in HCV care

Transcript

Anthony Martinez, MD: It sounds like there [are] barriers on 3 levels––the patient, provider, and the system itself can be difficult to navigate, right? And one term that we frequently hear about is task shifting. And that’s a concept that can help us to overcome some of those barriers. Jordan, can you define that? What exactly does that mean? And how do you see that being important to…clos[ing] some of these gaps?

Jordan Mayberry, PA-C: Absolutely. Well what we know is that APPs [advanced practice providers], our nurse practitioners and our PAs [physician assistants], are valuable members of the health care system. And…now about 75 % of patients that have HCV [hepatitis C virus] are being managed by APPs. So I think it’s very important that we are educating our APP colleagues about this disease state, about these great and easy-to-use medications, so that we can continue to screen and treat these patients with the help of our APP colleagues.

Anthony Martinez, MD: So really they’re an essential component to achieve elimination. I mean, this is where the bulk of patients [are] being screened, [receiving a diagnosis, and being] actually treated, so we really need that support from the APP colleagues to…get this done. Tipu, do you see a similar role for task shifting within the addiction medicine community?

Tipu V. Khan, MD: Yes. This gets me really excited. I love this topic. The incidence, as we were [discussing] with the data with Mark, is young drug-using patients that are injecting drugs are really pushing the incidence of hep[atitis] C right now. And again, these patients are healthy. They’re not going in for health care elsewhere, but where do they go? They go to a methadone clinic. They go to their MAT [medication-assisted treatment] provider, the primary care doc[tor], to get their medications for opioid use disorder.… So when we see them there for that, that’s a perfect opportunity for us to screen and treat them. In my eyes, I really think that addiction medicine is [at] the forefront of hep[atitis] C treatment. As a fellowship director, I train all…my fellows [to recognize] that when you’re treating your patients for whatever substance use disorder they have, you need to be updated on the guidelines for screening, but you need to be comfortable with management because these patients may not go to the primary care doc[tor]. They may not go to a GI [gastrointestinal] doc[tor] or hepatologist or an infectious disease specialist. They may only come to you to get their buprenorphine prescription or their other MOUD [medications for opioid use disorder].… So when you [have] them, you’ve got to feel comfortable treating [them]. And I do think that colocalization of treatment under the same roof by addiction medicine for hep[atitis] C is going to be important in eradication.

Anthony Martinez, MD: Tipu, I’ll pose this question to both you and Jordan. Do you see hep[atitis] C as serving as a gateway to deal with some of their other comorbidities, whether it’s addiction medicine or addiction comorbidity, or if they have some of the primary care comorbidity, do both of you see that hep[atitis] C leading to potentially dealing with some of these other issues?

Tipu V. Khan, MD: I think it’s a 2-way street, actually.… It goes both ways. In my practice, we’ve had a lot of patients that come in for their MOUD…who are then screened and we find out they have hep[atitis] C, and it opens a gateway for getting their hep[atitis] C treated but also establishing some basic primary care. And it definitely goes the other way around. In our primary care clinic, a lot of patients [are] refer[red] to us that were diagnosed with hep[atitis] C by the [emergency department] or wherever else they came from. And [we ask,] “How’d you get hep[atitis] C? Oh, let’s talk about your opioid use disorder. Do you know that we’ve got meds for opioid use disorder?” And they really kind of…integrate treatment to both.

Jordan Mayberry, PA-C: Yes, absolutely. I think as an APP, we may get a little bit more time to spend with these patients.... So when we’re talking about treating their hep[atitis] C, this can be a time that we can also address other primary care issues with these patient populations.

Anthony Martinez, MD: I think that’s important in that trust building, right? That time that you…are able to spend with patients that really builds that relationship is critical.

Transcript was AI-generated and edited for clarity and readability.