Knowledge, Attitudes and Practice Patterns of Prescribing Providers Related to Hepatitis C Screening and Treatment -- District of Columbia, 2018

Background: Chronic hepatitis C (HCV) carries a significant risk of liver cirrhosis, hepatocellular carcinoma, and the need for liver transplant. Since 2014, directly-acting antiviral medications (DAA) became available and have cure rates over 90%. Despite a greater push to treat patients in the District of Columbia (DC) through less financial restrictions and attempts to expand treatment to the primary care setting, only 25% of HCV patients in DC have achieved undetectable HCV RNA levels. This suggests a possible lack of capacity for providers to diagnose and treat HCV. Aim: The purpose of this study was to identify needs in capacity building and structural and individual-level provider barriers to diagnosing and treating patients with chronic HCV for all prescribers in the DC area, with the overarching goal of expanding HCV care to accelerate HCV elimination. Methods: An internet-based, anonymous survey was sent to physicians, nurse practitioners, and physician assistants in the District of Columbia assessing knowledge, attitudes, and practice patterns related to the diagnosis and treatment of patients with HCV. The primary outcomes were knowledge, attitudes about HCV treatment and interest in further HCV training. Key Results: 153 (1.5%) prescribers completed the survey, including 35 (23%) nurse practitioners (NP), 86 (56%) primary care physicians (PCP), 11 (7%) speciality physicians (infectious diseases, gastroenterology, or hepatology), and 21 (14%) physicians with unidentified specialties. The majority of providers identified as white females who have been in practice ≤ 10 years. Fifty-one percent, 71%, and 82% of NPs, PCPs, and specialty physicians, respectively, scored 7/9 on HCV screening knowledge (p-value \u3c.05). Three percent, 7%, and 55% of NPs, PCPs, and specialty physicians, respectively, scored ≥3/4 on HCV treatment knowledge (p-value \u3c.0001). Forty percent of all respondents believe HCV treatment should be provided primarily by specialists, and 35% believe HCV treatment should be provided by primary care providers. Forty-six percent of all providers believe personally building HCV treatment capacity in their clinic would be beneficial while 71% believe HCV treatment is important in their patient communities. Conclusion: These data suggest that the majority of NPs and PCPs are up to date on HCV screening guidelines, but not treatment guidelines. Given that a significant portion of providers believe HCV treatment should be done in the primary care setting in the era of DAA agents, and that HCV treatment is important in their patient communities, such clinics would benefit from expanding HCV treatment capacity