Original Article

Open Access: Using Community Paramedicine to Treat Hepatitis C Virus in Upstate South Carolina

Authors: Susan Maria Cordero Romero, BS, Mirinda Ann Gormley, PhD, MSPH, Jennica Siddle, MD, MPH, Wesley R. Wampler, BS, NRP, Prerana Roth, MD, MPH, Phillip Moschella, MD, PhD

Abstract

Objectives: Hepatitis C virus (HCV) is an infection of the liver that can lead to significant liver damage and hepatocellular carcinoma. Individuals born between 1945 and 1965 and individuals with intravenous drug use represent the largest HCV demographics and often experience barriers to treatment. In this case series, we discuss a novel partnership between community paramedics (CPs), HCV care coordinators, and an infectious disease physician to provide HCV treatment to individuals with barriers accessing care.

Methods: Three patients tested positive for HCV within a large hospital system in the upstate region of South Carolina. All of the patients were contacted to discuss their results and scheduled for treatment by the hospital’s HCV care coordination team. Patients who expressed barriers to attending in-person appointments or were lost to follow-up were offered a telehealth appointment facilitated by CPs performing a home visit with the added ability to draw blood and perform a physical assessment guided by the infectious disease physician. All of the patients were eligible for and prescribed treatment. The CPs assisted with follow-up visits, blood draws, and other patient needs.

Results: Two of the three patients connected to care had an undetectable HCV viral load following 4 weeks of treatment, whereas the third was undetectable after 8 weeks. Only one patient reported a mild headache that was potentially linked to the medication, whereas the others did not report any adverse effects.

Conclusions: This case series highlights the barriers experienced by some HCV-positive patients and a distinctive plan to address impediments to access for HCV treatment.
Posted in: Infectious Disease136

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References

1. Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013–2016. Hepatology 2018;69:1020–1031.
 
2. Centers for Disease Control and Prevention. Hepatitis C questions and answers for health professionals. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#ref03. Published August 7, 2020. Accessed February 4, 2022.
 
3. Calner P, Sperring H, Ruiz-Mercado G, et al. HCV screening, linkage to care, and treatment patterns at different sites across one academic medical center. PLOS One 2019;14:e0218388.
 
4. Douthit N, Kiv S, Dwolatzky T, et al. Exposing some important barriers to health care access in the rural USA. Public Health 2015;129:611–620.
 
5. Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006–2012. Clin Infect Dis 2014;59:1411–1419.
 
6. Mason S, Knowles E, Colwell B, et al. Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial. BMJ 2007;335:919.
 
7. Chan J, Griffith LE, Costa AP, et al. Community paramedicine: a systematic review of program descriptions and training. CJEM 2019;21:749–761.
 
8. Gregg A, Tutek J, Leatherwood MD, et al. Systematic review of community paramedicine and EMS mobile integrated health care interventions in the United States. Popul Health Manag 2019;22:213–222.
 
9. Choi BY, Blumberg C, Williams K. Mobile integrated health care and community paramedicine: an emerging emergency medical services concept. Ann Emerg Med 2016;67:361–366.
 
10. Khoshrounejad F, Hamednia M, Mehrjerd A, et al. Telehealth-based services during the COVID-19 pandemic: a systematic review of features and challenges. Front Public Health 2021;9:711762.