Benjamin Young, MD, PhD; Fabienne Laraque, MD, PhD; Mario U. Mondelli, MD, PhD; Kosh Agarwal, MD; Jeffrey Kwong, DNP, MPH, ANP-BC


April 14, 2014

In This Article

Editor's Note:
During the International Conference on Viral Hepatitis, held recently in New York, participants in a panel discussion titled "Strengthening the HCV Continuum of Care"[1] convened afterward for a discussion. During the conversation, they discussed why the continuum of care is important in treating hepatitis C for both patients and providers.

The Continuum of Care for Hepatitis C

Benjamin Young, MD, PhD: Hello. I am Dr. Benjamin Young, Vice President and Chief Medical Officer of the International Association of Providers of AIDS Care. We are here in New York at the International Conference on Viral Hepatitis, and I am pleased to be joined by an expert panel from around the world to discuss issues related to strengthening the hepatitis C continuum of care. With us today are Dr. Fabienne Laraque from the New York City Department of Health and Mental Hygiene, Dr. Mario Mondelli from Pavia University in Italy, Kosh Agarwal from King's College in London, and Jeffrey Kwong from Columbia University.

Dr. Laraque, you started this conversation earlier with your thoughts about the continuum of care here in New York. Can you tell us more about that?

Fabienne Laraque, MD, PhD: The importance of the continuum of care is that just diagnosing and treating hepatitis C virus (HCV) infection is not enough. We are going to need a program that will educate providers in the community; provide and expand screening and testing; facilitate active linkage to care and access to treatment medications; and also coordinate care, treatment, and support for the patient. From testing the patient all the way to seeing the patient at the end of the treatment with active care coordination, treatment, and patient support, whether the patient completes the entire continuum is going to be key for controlling HCV infection.

Dr. Young: Dr. Mondelli and Dr. Agarwal, you are from, respectively, Italy and England. How do you see the continuum working, and what are the prevailing thoughts about these issues in your countries?

Mario U. Mondelli, MD, PhD: I agree entirely with Dr. Laraque that the continuum of care is essential to the treatment of chronic HCV infection. Italy and England are very similar in terms of the organization of the healthcare system. We have a public health system, with the usual problems that arise from this particular organization.

In Italy, the tertiary referral hospital is a hub for the patient to be seen. The general practitioner does very little to ensure the continuum of care in the territory. Everything is left to the specialist physician, who performs all of the actions involved in the treatment of the patient.

I wonder whether this can be strengthened. The resources, at least in our country, are unfortunately limited with respect to implementing the continuum of care that Dr. Laraque described.

Kosh Agarwal, MD: I agree with Mario. The issues that we are discussing are universal. There is no doubt that all healthcare environments are limited by resources.

HCV is a very interesting model of chronic disease, which has a dichotomy in that some patients present with advanced liver disease, cirrhosis, or liver cancer and have significant health resource utilization. The focus is now on the newer therapies that are curative, and it is not always recognized that we can talk about a cure for HCV.

On the other hand, we have the issue of education, screening, and prevention of transmission. Joining those together to provide a continuum, as Dr. Laraque has suggested, is a universal problem. Certainly in the United Kingdom, we don't diagnose all cases of HCV. We are treating only 3%-5% of the patients who are diagnosed. The cost implications, the education issues, the lack of targets, and the lack of a public health strategy to join those arms up cogently are major concerns.


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