| dc.description.abstract | INTRODUCTION: In 2016 the World Health Organization proclaimed a hepatitis C virus (HCV) elimination goal of a 90% decrease in new infections by 2030. Some providers are facing this prevalent disease through an organization called ‘Project ECHO’, Extension for Community Healthcare Outcomes, with Oklahoma State University Center for Health Sciences. Funded by OSU-CHS and Cherokee Nation Health Services, this collaborative model connects an interdisciplinary team of infectious disease physicians and pharmacists with community providers to discuss treatment for complex medical conditions. This unique resource proved valuable in providing additional care for an uninsured, chronic HCV patient in the Bedlam Longitudinal Clinic. She became the first patient of the Bedlam free clinics to be evaluated by the ECHO team and receive treatment.
CASE DESCRIPTION: The patient is a 60-year-old female with Hepatitis C diagnosed in 1981 after a blood transfusion secondary to a C-section. She is uninsured and treatment naïve. When she presented to the clinic there were concerns for hepatic fibrosis and decompensated disease. Along with a 20-pound weight loss within one year, her physical exam revealed a palpable liver 2-3 cm beyond the costal margin and a positive fluid wave. Her AFP was 7.5 and increased to 9.1 four months later, which led to obtaining an unremarkable abdominal ultrasound with the recommendation for a follow-up CT scan. Her case was presented to the ECHO team who collaborated to formulate recommendations for continuing her work-up, beginning treatment, and disease monitoring upon treatment completion. Based on their expert recommendations, the patient received a triple phase liver CT scan through the Medical Access Program (MAP) and a pharmaceutical patient assistance program approved free treatment with Epclusa.
DISCUSSION: When this patient presented to clinic, she believed HCV treatment would never be an option for her financially. There was an underlying fear she would become decompensated or develop hepatocellular carcinoma for which her risk is high. Without the pro-bono support from the ECHO team and assistance programs, her opportunity for treatment would have likely been delayed without expert guidance or denied entirely. For the first time in 39 years, this patient will be able to move forward knowing HCV will be her past and not her future. | en_US |
