1. TESTING FOR HEPATITIS C: TAILORING AN APPROACH FOR YOUR PRACTICE AND YOUR PATIENTS Prepared by: Deborah Graham, MSPH; Elizabeth Horsley, MSJ; & Kim Kimminau, PhD AAFP National Research Network Leawood, KS

2. Disclosures It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/ invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and if identified, they are resolved prior to confirmation of participation. Only these participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

3. Introductions

4. Who We Are

5. What We Do: Value to Individual Clinicians and Practices NRN Update – 400+ practices – Practice performance reporting / quality metrics Projects with attention to workflow and office constraints – Colorectal cancer screening – Pain management tools in primary care settings – Overweight/obesity in adults and adolescents – Asthma IQ – Asthma Apgar – Post-partum depression – Use of new technologies (ex. Ipad) to collect patient information

6. Goals of this NRN Session Overview of Hepatitis C Interactive discussion on: – How do you screen for Hep C in your practice? – How do you follow-up positive screens? – What are challenges and possible solutions? – What questions do you have around Hep C that you would like answers to?

7. Quick Overview of HCV Most common blood-borne infection in U.S. Infectious routes: 1° route: infected blood (transfusion from unscreened donors or through use of injecting drugs) 2° route: Perinatal, occupational and sexual exposure No vaccine

8. HCV Overview, continued Many are asymptomatic, unaware of being infected Condition becomes chronic in at least 75% of HCV infected individuals Of the 75% chronic, 25% of them go on to advanced disease – Fibrosis – Cirrhosis – May need liver transplant – Over 12K deaths/year

9. Screening for HCV Infection Begin screening process with Antibody to HCV (Anti-HCV) test If Anti-HCV results are positive, diagnosis of HCV infection may be confirmed by: – Samples with high signal-to-cut-off ratios – Nucleic acid testing (NAT) for HCV RNA – Recombinant immunoblot assay

10. Source: CDC, www.cdc.gov/hepatitis

11. Target Populations for Screening: Updated CDC Guidelines Use (or have used) injecting drugs Received a blood transfusion prior to 1992 All adults born between 1945 and 1965 – Estimates that “baby boomers” account for ¾ of all HCV infections in U.S. – Anti-HCV prevalence is five times higher than that of adults from other age cohorts

12. Draft Screening Recommendation Statement from USPSTF High-risk adults should be screened (Grade B) Clinicians can consider offering screening to adults born between 1945 and 1965 (Grade C) – Comment period on USPSTF draft recommendations ends December 24, 2012 – AAFP is reviewing draft and will update its own 2004 HCV recs after final USPSTF recs published in 2013

13. Current NRN Research on HCV Few tools to aid in conversation between clinician and patients CDC and Battelle Memorial Institute developed a manual – AAFP NRN is field testing the manual in primary care settings

14. NRN Research on HCV, continued Includes modules on: – Pre-test counseling – Disclosing a positive result Goal of project is to provide feedback on value, applicability, ease of use, and functionality of manual; and provide recommendations for improvement

15. Discussion

16. What do you currently do for asymptomatic, baby boomer patients in terms of HCV screening?

17. How do you triage patients to be screened?

18. How do you approach follow-up for a positive screening test result?

19. What barriers do you come across with HCV screening and follow-up?

20. What are potential solutions to these barriers?

21. What questions do you have about HCV that could be addressed by the NRN? Examples: Screening modalities Overcoming barriers Practice operations, implementation Patient education/awareness

22. Thank you for your time and feedback! Deborah Graham, MSPH (dgraham@aafp.org) Elizabeth Horsley, MSJ (ehorsley@aafp.org) AAFP National Research Network Leawood, KS