A team of researchers from UT Health San Antonio and UT Southwestern have published a study in the Journal of Cancer Education showing that a new, shortened training program for health care providers may increase screenings for hepatitis C virus (HCV) across the region.
Bertha “Penny” Flores, PhD, APRN, WHNP-BC, assistant professor in the School of Nursing, is the principal investigator of the UT Health San Antonio study site that evaluated the new education program in South Texas. The majority population in South Texas is Hispanic, and studies have shown that Hispanics often have more advanced liver disease at the time of hepatitis C diagnosis.
“Hispanic populations are in dire need of HCV screening to avert complications of advanced disease such as liver cancer and end-stage liver disease, both of which can be deadly,” Dr. Flores said.
The training program was conducted from February 2016 through August 2019 through five Federally Qualified Health Centers in San Antonio and South Texas, where primary care is delivered to underserved populations with reimbursement from the federal government.
For the training program, an internist, liver specialist and community health worker developed two versions of a 50-minute presentation. One was geared toward primary care physicians, nurse practitioners and physician assistants. The second version was directed to associate care providers including medical assistants, administrative professionals, nurses, licensed vocational nurses and community health workers. The researchers also created a survey to gauge knowledge and attitudes about hepatitis C screening and treatment before and after the presentation.
Of the 287 participants, 104 (36%) were primary care physicians and 183 (64%) were associate care providers. Pre-training surveys showed that both primary care physicians and their associates were familiar with the national guidelines recommending hepatitis C screening for the largest group affected by hepatitis C — individuals born between 1945 and 1965. However, they were not as aware that, over the past decade, more young people have been testing positive due to opioid use and that the national screening recommendations have been expanded to include adults ages 18 to 79.
The post-training survey showed that primary care providers and associate providers more strongly supported testing and linking patients to care than they did in the pre-training survey. They also were more concerned about the impact of chronic hepatitis C on the community. The largest improvement in knowledge and attitude in the associate provider group was the desire to link affected individuals to care.
More than 2.4 million people in the U.S. are estimated to have chronic hepatitis C. Research has shown that the virus contributes to advanced liver disease, liver cancer and death. Yet because individuals may have the virus for many years before they notice any symptoms, more than half of the people who test positive for hepatitis C are unaware that they have it until after it has damaged their liver or caused cancer.
For these reasons, the United States Preventive Services Task Force in 2013 recommended that individuals born between 1945 and 1965 be screened for hepatitis C; however only 25% of this group has been screened. Since 2013, more effective direct antiviral treatments have been developed and more young people have been testing positive for hepatitis C, leading the task force in 2020 to expand its testing recommendation to all adults from ages 18 to 79.
The work was funded by $2.5 million from the Cancer Prevention & Research Institute of Texas to UT Health San Antonio and UT Southwestern.
Additional researchers and contributors to the study include Andrea Fernandez, MBA, MPH, from the UT Health San Antonio School of Nursing; Chen-Pin Wang, PhD, from the Department of Population Health Sciences and the Center for Research to Advance Community Health (ReACH); Raudel Bobadilla, CHW, and Ludvina Hernandez, CHW, from ReACH; Mamta K. Jain, MD, overall principal investigator of the study from UT Southwestern, and Barbara J. Turner, MD, MSEd, MACP, from the Gehr Center for Health Systems Science and Innovation in the Keck School of Medicine at the University of Southern California. Dr. Turner was the original principal investigator of this research when she was a faculty member at UT Health San Antonio.