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SHADE SAYS...TREAT FIRST! Access to Hepatitis C Treatment in San Francisco

Learn about the Hepatitis C treatment program at the San Francisco AIDS Foundation, focusing on a nurse practitioner-led approach in a community-based syringe access center. Discover the 5 prongs of the program, eligibility criteria, outcomes, and how they are making a significant impact on Hep C prevention and treatment. Join the movement to save lives and spread the word!

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SHADE SAYS...TREAT FIRST! Access to Hepatitis C Treatment in San Francisco

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  1. Shade says… Treat first! Establishing Access to Hepatitis C Treatment in a Nurse Practitioner-led Community-Based Syringe Access Center in San Francisco Pauli Gray (He/Him/His) Sr SAS HCV Wellness Coordinator Pierre-Cédric Crouch, PhD, ANP-BC, ACRN (He/Him/His) Director of Nursing Magnet @Strut

  2. Disclosures We have no disclosures San Francisco and California have privilege which makes this work easier than other places San Francisco AIDS Foudation

  3. Objectives 1 Why we do this 2 Walk through Hep C Health Program San Francisco AIDS Foudation

  4. SHADE SAYS... TREATFIRST! 5 PRONGS: • TREAT at Syringe Access sites • NO HOOPS to jump through • OFFER HCV MED STORAGE • SUPPORT/WRAP-AROUND SERVICES • SECONDARY GOALS

  5. TAKEAWAYS • Each time we partner to cure a single case of PWID Hep C, we are helping prevent 25 others from being infected • We have the unique opportunity of curing the deadliest communicable disease and the honor of facilitating a huge change and providing hope in people’s lives.

  6. San Francisco AIDS Foundation Mobile Testing Unit Harm Reduction Center Magnet at Strut Main Downtown Office SAN FRANCISCO AIDS FOUNDATION

  7. Hepatitis C Program Hep C Treatment Priority Communities • Out of care Expanded Magnet HCV Testing Priority Communities • IDU, Gay/MSM, Kink/Blood, HIV Positive Hep C Navigation and Treatment Support • Tx Breakfast • Medication Storage End Hep C SF San Francisco AIDS Foundation

  8. Screening H&P: Focus on Cirrhosis Labs: CBC, LFTs, PT-INR, HCV RNA, HCV GT HCV Counseling Prior Authorization Initiation Within 1-2 weeks of screening HCV Counseling Adherence Counseling Week 4 HCV Counseling Adherence Counseling Labs: CBC, LFTs, HCV RNA Week 8, 12 HCV Counseling HCV Reinfection Counseling SVR12 HCV Reinfection Counseling Labs: HCV RNA Harm Reduction Center Visit Schedule Ongoing treatment breakfast, medication storage, & HCV counseling by navigators San Francisco AIDS Foundation

  9. Hep C Treatment Program Eligibility • Generally Healthy over age 18 • Exclude decompensated cirrhosis • Prefer monoinfected Hep C • May work with HIV coinfected with PCP • Do not bill professional fees • Allows us to accept most insurance for labs and meds • No need to change medical home • Unable to treat Kaiser or VA clients • Able to treat uninsured and undocumented clients • Abbvie and Gilead Patient Assistance San Francisco AIDS Foundation

  10. Outcomes Clients Screened 86 Clients Initiating treatment 61 Clients Completing Treatment 44 (14 active) Clients Achieving SVR12 21/23 (91%) Clients with Incomplete Treatment 3 Clients not initiating 6-Cleared Hep C 2-Medically complex 1-Enrolled in Research 3-Did not return to initiate 3-other Clients Not Achieving SVR12 1 Reinfected 1 Adherence Cross-sectional data from November 9, 2018 San Francisco AIDS Foundation

  11. Demographics San Francisco AIDS Foundation

  12. Demographics San Francisco AIDS Foundation

  13. Demographics San Francisco AIDS Foundation

  14. Discussion People living with active substance use can successfully be cured of Hepatitis C. Differentiated Service Delivery of Hepatitis C treatment in a Syringe Access Service can reach communities who traditional healthcare settings have struggled to reach. San Francisco AIDS Foundation

  15. Facilitators Facilitators • A ”treat first” approach allows for clients to focus on Hepatitis C treatment • Newer 8 week treatments facilitate cures • Expanded Nursing Scopes of Practice • No billing of professional fees • Reduced barriers for Medi-Cal/Medicaid coverage San Francisco AIDS Foundation

  16. Barriers Barriers • Lack of Nurse Practitioner Autonomy in California • Blood Specimen Collection • Microtainers, Newer technologies use capillary sticks • Funding to expand program San Francisco AIDS Foundation

  17. Thank You! To all the clients who put their trust in our team. All SFAF staff and volunteers and the San Francisco community who support our work. Protocols: https://tinyurl.com/hepcSFAF San Francisco AIDS Foundation

  18. TREAT FIRST, SAVE LIVESSPREAD THE WORD

  19. Contact Info Pauli Gray pgray@sfaf.org Pierre-Cedric Crouch pcrouch@sfaf.org Janessa Broussard jbroussard@sfaf.org San Francisco AIDS Foundation

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