Despite improved HCC screening and surveillance guidelines, significant race/ethnicity-specific disparities in hepatocellular carcinoma remain, disproportionately affecting medically underserved minorities along U.S.-Mexico Border. According to the City of El Paso’s Department of Public Health Notifiable Disease Records, a total of 4,631 HCV chronic cases were reported between 2010 and 2016 in El Paso County alone. In 2015, the incidence rate for chronic HCV was 83.4 per 100,000 (a 21.3% increase from 2013) and for chronic HBV, 8.8 per 100,000 (a 3.4% increase from 2013). This high prevalence rate of chronic Hepatitis was also statistically notable in other border regions.

As for HBV s...

Read More

Despite improved HCC screening and surveillance guidelines, significant race/ethnicity-specific disparities in hepatocellular carcinoma remain, disproportionately affecting medically underserved minorities along U.S.-Mexico Border. According to the City of El Paso’s Department of Public Health Notifiable Disease Records, a total of 4,631 HCV chronic cases were reported between 2010 and 2016 in El Paso County alone. In 2015, the incidence rate for chronic HCV was 83.4 per 100,000 (a 21.3% increase from 2013) and for chronic HBV, 8.8 per 100,000 (a 3.4% increase from 2013). This high prevalence rate of chronic Hepatitis was also statistically notable in other border regions.

As for HBV statistics, HBV infection is higher in foreign born Hispanics than in US-born Hispanics and non-Hispanic whites. The proposed six county service area — Region 10 — also has some of the highest HCC age-adjusted cancer mortality rates in Texas, with many of the rural areas lacking basic access to screening services.

The West Texas HCV Screening and Linkage to Care program provides a comprehensive HCV and HBV screening and linkage to care program to residents living in El Paso, Culberson, Presidio and Brewster counties. All of the services have shown to have patient efficacy and follow recommended clinical guidelines. Hepatitis C virus (HCV) screenings will be offered to patients born between 1945 and 1965 or those at-risk and to patients at multiple rural health center sites for those persons at high risk based on USPSTF recommendations.

Linkage to care services will also be provided to the rural counties of Region 10, including linkage to care and medication assistance services. Services will include comprehensive patient navigation services, insurance application assistance, medication assistance, scheduling with HCV specialist, and reminder calls and/or text messages for appointments, including linkage and referrals to Centro San Vicente’s Hepatitis C Treatment Clinic.

Community health workers (CHW) will also be also incorporated into the program services mix to provide community outreach and education as well as to promote new testing sites among selected El Paso communities as well as screening and linkage services being offered in the rural counties of West Texas. This program also offers professional education services to meet the needs of community-based physicians and front line workers at primary care settings, which includes capacity building interventions to ensure that these providers have access to training and resources necessary to provide their patients with care that adheres to the most current standards of care.

The project has following three goals: 1. Reduce Hepatocellular cancer mortality rates resulting from undiagnosed or late diagnosed HCV and HBV infections among residents living in Culberson, Presidio and Brewster Counties; 2. Residents living in Region 10 have increased access to HCV treatment and survivorship services; and, 3. Reduce Hepatocellular cancer mortality rates resulting from undiagnosed or late diagnosed HCV and HBV infections among the community residents living in El Paso County communities of Socorro, San Elizario and Fabens.

Beyond the evidence-based approaches to be used in the West Texas HCV Screening and Linkage to Care Program, this project is unique in the following ways: 1). Provides Hepatitis screening services in the rural communities of Region 10; 2). Replicates Gilead’s Project FOCUS, a proven, sustainable, screening model of care among two rural providers; 3.) Establishes new screening sites in hard-to-reach communities located in El Paso County; 4.) Provides rural and urban patients with comprehensive patients navigation and linkage to care services; and, 5). Offers providers professional education services through Baylor St. Luke’s Project E.C.H.O. Telehealth Project in Houston and the South Central AETC.

Moreover, this program is innovative because it provides services in sparsely populated communities that are often overlooked because of a lack of available funds or resources and works within the existing capacities of the rural provider network.

The West Texas HCV Screening and Linkage to Care program will have a significant impact in rural communities of West Texas because it will integrate routine hepatitis screening services into a clinical setting and in rural communities often overlooked because of their limited resources. Additionally, using Project Gilead’s Focus Program’s model for routine screening will help to strengthen clinical systems and will accomplish the following: 1. Integrating testing and screening services into clinic flow; 2. Enhancing electronic medical records systems; 3. Enhancing policies and systems to accommodate routing of screenings; and, 4. Develop ongoing professional training, feedback and quality improvement services.

Read Less