A Model for Primary Care Hepatitis C Management in Underserved Communities

The Extension for Community Healthcare Outcomes (ECHO) model, which uses video-conferencing technology to train primary care physicians to manage complex diseases, is effective for treating patients with hepatitis C virus (HCV) infection in underserved communities. Use of the model is associated with high rates of cure, and rates of sustained virological response are similar to those among patients treated at academic medical centers.

Arora and associates conducted a prospective cohort study to compare treatment at a university clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons. They enrolled 407 patients who had chronic HCV infection and had received no previous treatment for the infection.

The rate of sustained virological response was 58.2% in patients treated at ECHO sites and 57.5% in those treated at the university clinic; among patients with HCV genotype 1 infection, it was 49.7% at ECHO sites and 45.8% at the clinic. Overall, more patients in the clinic cohort had a serious adverse event and more had a serious adverse event that led to termination of treatment.

The authors noted that the ECHO model has the potential for being replicated elsewhere with collaboration between community providers and academic specialists.