Coinfection with HIV and hepatitis C virus (HCV) results in a three-fold increase in progression to end stage liver disease and cirrhosis compared to HCV alone. Although curative treatments exist, less than one quarter of people with HCV are linked to care and even fewer have received treatment. The proposed study is a single-blinded, randomized controlled trial to improve the HCV treatment cascade among people coinfected with HIV. This study will test whether a nurse case management intervention can 1) improve linkage to HCV care and 2) decrease time to HCV treatment initiation among people coinfected with HIV. Participants will be recruited from an urban HIV clinic that serves a primarily low income African American population with 50% of patients coinfected with HIV/HCV. Barriers to HCV linkage and treatment among people with HIV include low knowledge, competing demands, and HIV/HCV drug interactions, which can be addressed with nurse case management. The nurse case management intervention will be conducted in two phases. The first phase includes nurse-initiated referral, strengths-based HCV education, patient navigation, and appointment reminders. The second phase includes care coordination of antiretroviral modifications to minimize the impact of HIV/HCV drug interactions. The intervention components are guided by the Andersen Behavioral Model of Health Services Use, which will be used to explain why participants engage or do not engage in HCV care. The findings from this study will ensure that the most effective linkage to care and treatment approach is integrated into care of this population. This study supports the President's Care Continuum and Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, as well as the latest Guidelines for Use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents. This study's purpose is directly aligned with the NINR's strategic plan to improve health in minority and underserved populations through evidence-based interventions that promote wellness and self-management.

Public Health Relevance

Effective all-oral medications are finally available to cure hepatitis C virus (HCV), which affects 3.5 million Americans and one-in-four people living with HIV. However, many barriers exist that prevent people with HIV/HCV co-infection from linking to care, including low knowledge, competing demands, and HIV/HCV drug interactions. The proposed study is a randomized, controlled trial to test whether receiving a nurse case management intervention will increase linkage to HCV care and treatment among persons co-infected with HIV/HCV to decrease liver disease and death in this population.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
5F31NR016200-03
Application #
9443682
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Banks, David
Project Start
2016-03-16
Project End
2018-07-31
Budget Start
2018-03-16
Budget End
2018-07-31
Support Year
3
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Farley, Jason E; Starbird, Laura E; Anderson, Jill et al. (2017) Methodologic considerations of household-level methicillin-resistant Staphylococcus aureus decolonization among persons living with HIV. Am J Infect Control 45:1074-1080