MMWR Morb Mortal Wkly Rep. 2014 May 9;63(18):393-8.
Hepatitis C virus (HCV) infection is the leading reason for liver transplantation and a common cause of hepatocellular carcinoma, the most rapidly increasing cause of cancer-related deaths in the United States. Of the approximately 3 million persons living with HCV infection in the United States, an estimated 38% are linked to care, 11% are treated, and 6% achieve cure. Recent development of highly effective and well-tolerated medications, such as sofosbuvir and simeprevir, to treat chronic HCV infection shows promise in curbing rising HCV-related morbidity and mortality, with the potential to cure >90% of patients. To fully benefit from these new treatments, improvement in linkage to care and treatment is urgently needed.* Lack of provider expertise in HCV treatment and limited access to specialists are well-documented barriers to HCV treatment. In September 2012, CDC funded programs in Utah and Arizona to improve access to primary care providers with the capacity to manage and treat HCV infection. Both programs were modeled on the Extension for Community Healthcare Outcomes (Project ECHO), developed by the University of New Mexico's Health Sciences Center in 2003 to build primary care capacity to treat diseases among rural, underserved populations through videoconferencing and case-based learning in "teleECHO" clinics. To assess the effectiveness of these programs in improving primary care provider capacity and increasing the number of patients initiating treatment, process and patient outcome data for each state program were analyzed. In both states, Project ECHO was successfully implemented, training 66 primary care clinicians, predominantly from rural settings. Nearly all (93%) of the clinicians had no prior experience in care and treatment of HCV infection. In both states combined, 129 (46%) of HCV-infected patients seen in teleECHO clinics received antiviral treatment, more than doubling the proportion of patients expected to receive treatment. These findings demonstrate Project ECHO's ability to expand primary care capacity to treat HCV infection, notably among underserved populations.
丙型肝炎病毒 (HCV) 感染是肝移植的主要原因，也是美国肝细胞癌的常见病因，也是导致癌症相关死亡的主要原因。在美国，大约有 300 万丙型肝炎病毒感染者，估计有 38%得到了治疗，11%得到了治疗，6%得到了治愈。最近开发的高效且耐受性良好的药物，如索非布韦和西美瑞韦，治疗慢性丙型肝炎感染，有望降低丙型肝炎相关发病率和死亡率，有潜力治愈>90%的患者。为了充分利用这些新的治疗方法，迫切需要改善与治疗相关的联系并增加治疗机会。*缺乏丙型肝炎治疗方面的专业知识以及获得专家治疗的机会有限，这些都是丙型肝炎治疗的公认障碍。2012 年 9 月，疾病预防控制中心在犹他州和亚利桑那州资助了一些项目，以改善具有管理和治疗丙型肝炎感染能力的初级保健提供者的服务渠道。这两个项目都是在新墨西哥大学卫生科学中心于 2003 年开发的扩展社区医疗保健成果（Project ECHO）项目的基础上建立的，该项目通过视频会议和“远程 ECHO”诊所中的基于案例的学习，建立了农村和服务不足人群的初级保健能力，以治疗疾病。为了评估这些项目在提高初级保健提供者能力和增加开始治疗的患者数量方面的有效性，对每个州项目的流程和患者结果数据进行了分析。在这两个州，Project ECHO 都成功实施，培训了 66 名初级保健临床医生，主要来自农村地区。几乎所有（93%）的临床医生以前都没有治疗丙型肝炎感染的经验。在这两个州，在远程 ECHO 诊所就诊的 129 名（46%）丙型肝炎感染患者接受了抗病毒治疗，使接受治疗的患者比例增加了一倍多。这些发现表明 Project ECHO 有能力扩大初级保健能力以治疗丙型肝炎感染，尤其是在服务不足的人群中。
