Target Audience

Providers and clinical staff interested in providing treatment and care to individuals diagnosed with Hepatitis C.

Purpose

This interactive web-based program provides community-focused primary care clinicians an opportunity to become experts in delivering Hepatitis C care through a mentoring-based initiative. Project ECHO, developed by Dr. Sanjeev Aurora at the University of New Mexico (UNM) in 2003, provides a framework for sharing expertise across the state and, as a result, will help patients achieve a viral cure and avoid the downstream sequela associated with HCV without leaving the providers they trust and the communities where they live and work. Interested providers do not have to have any prior experience in treating Hepatitis C to participate in HCV ECHO.

Learning Objectives

1. Describe the epidemiology of and gaps in identifying pediatric candidates for HCV therapy.
2. List treatment options for children with chronic HCV infection.
3. Review treatment challenges in pediatric populations.

Speaker

Onyema Ogbuagu, MBBCh, FACP, FIDSA
Associate Professor of Medicine (AIDS); Affiliated Faculty, Yale Institute for Global Health

I am an Associate Professor of Medicine in the clinician-educator track and Director of the Yale antivirals and Vaccines research program (formerly HIV Clinical Trials program) of the Yale AIDS Program, Section of Infectious Diseases of the Yale School of Medicine.

My clinical responsibilities include educating and training medical students, residents, and infectious diseases fellows in various capacities in inpatient and outpatient settings and through structured coursework and other teaching sessions. As a faculty of the HIV training track of the Yale-Internal Medicine primary care program and the Human Resources for Health program in Rwanda (2013 to 2019), I have extensive experience with curriculum development, structuring residency training programs, and mentoring residents and faculty. In Rwanda specifically, I have and continue to mentor medical residents and junior faculty in quality improvement and clinical research projects that are locally relevant and address important infectious diseases-related problems (particularly the HIV/AIDS epidemic and antimicrobial resistance).

Furthermore, I have facilitated meaningful educational and research collaborations between faculty and trainees across institutions. As the program director of World Bank and HRSA-funded efforts supporting the Liberia College of Physicians and Surgeons (LCPS)–run Internal medicine residency training program, I have overseen the selection and deployment of faculty to Liberia. I am responsible for educational programs and activities to strengthen the residency training program. Through an award from the National Academy of Sciences / USAID, I trained Liberia's first-ever Infectious Diseases physician, who received a fellowship from the West African College of Physicians in that specialty in 2022. My expertise and collective experiences have positioned me to design and run successful projects around capacity building in low-resource settings, including developing and implementing innovative and robust medical training and research programs for faculty, fellows, residents, and students.

Since 2017, I have been the director of the Yale AIDS Program's HIV clinical trials program and a principal investigator on numerous pharmacokinetic, phase 2, and 3 safety and efficacy trials of novel antiviral compounds (HIV, SARS CoV-2). I am also a lead investigator on the international DISCOVER trial evaluating TAF/FTC vs. TDF/FTC for HIV prevention among MSM and transgender women, as well as the PURPOSE-2 trial evaluating long-acting lenacapavir for PrEP among MSM, transmasculinizing and trans feminizing individuals as well as gender nonbinary individuals who have sex with men. I am also funded by NIAID (2023-25) for work advancing HIV PrEP for adolescent girls and young women in Liberia.

In response to the COVID pandemic, I have been Yale's principal investigator on multiple investigational therapeutic and preventative clinical trials for COVID-19, including remdesivir (now FDA approved), leronlimab and remdesivir and tocilizumab combination therapy as well as the Pfizer/BioNTech and GSK/Sanofi COVID-19 Vaccine trials. In addition, I am also the PI on multiple ongoing trials evaluating mRNA vaccines for other infectious diseases and vaccines for bacterial infection.

Professional Practice Gap - National

Hepatitis C virus (HCV) infection is a blood-borne infectious disease that causes substantial liver-related morbidity and an increased risk of liver cancer and death. HCV is often known as a “silent disease,” with few noticeable symptoms, especially in early-stage infection. Because of this, many individuals are unaware of their HCV until more serious, late-stage complications arise. Treatment is available for HCV, with success measured by the sustained viral response (SVR) rate at 12 to 24 weeks post-treatment (i.e., no detectable virus). Before 2014, an average of 48 to 70% of people achieved SVR with the available therapies; however, recent advances in therapeutic medications increased SVR rates to more than 95% in 2018. Achieving SVR can reverse the effects of early-stage fibrosis and slow the progression of cirrhosis to decompensation or hepatocellular carcinoma (HCC). This reduces liver-related mortality by 20-fold and all-cause mortality by 4-fold. Transmission of HCV can be prevented by avoiding direct exposure to contaminated blood or blood products, including objects that may have come in contact with contaminated blood, such as syringes and other drug paraphernalia. 

Over the last 14 years, the HCV epidemic has drastically changed in the U.S. Originally a disease affecting “baby boomers” (people born between 1945 and 1965), HCV has reemerged as a syndemic with opioid use and overdoses, methamphetamine use, and HIV. In 2010, approximately 3.5 million Americans were living with chronic HCV. According to CDC data, HCV kills more Americans than any other infectious disease. In addition, HCV is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the U.S. In 2013, deaths from HCV-related causes surpassed the total combined number of deaths from 60 other infectious diseases reported to the CDC, including HIV and tuberculosis. In 2014, HCV-related deaths reached an all-time high, with more than 19,600 deaths reported. At the same time, there has been a marked simultaneous increase in the number of people newly diagnosed with HCV across the U.S., particularly among people with a history of injection drug use. The U.S. experienced marked increases in hospital admissions for acute HCV and opioid injection between 2004 and 2014, with the number of people newly diagnosed with HCV more than doubling between 2010 and 2014.

National-level programs to control the burden of HCV have focused primarily on the older cohort of people with HCV. These programs include screening for HCV in the baby-boomer cohort (born 1945 to 1965) and programs offered through the Veteran’s Administration (V.A.) to diagnose and cure all veterans with HCV. Despite these efforts, barriers to treatment still exist at the state Medicaid level, as evidenced in many states by restrictions on treatment, including fibrosis scarring requirements that preclude treatment for people with early-stage liver disease. Universal procedures exist to prevent HCV transmission in medical settings across the U.S. (though localized outbreaks may still occur when procedures fail). However, the recent opioid crisis and increased methamphetamine usage in some parts of the country present new challenges for HCV prevention efforts. Presently, policies to prevent transmission among drug users are entirely state-specific, and in many states, these policies do not exist.

Professional Practice Gap - Iowa

At the beginning of 2017, there were 26,900 Iowans with chronic HCV (HCV RNA+ viremic infections) in Iowa. Approximately 59% of people with chronic HCV were previously diagnosed (n= 15,900), with around 1,500 people being diagnosed annually, and 8% of people with diagnosed HCV (n=2,200) being initiated on treatment annually. An estimated 870 people were acquiring HCV annually, with an incidence rate of 57.8 per 100,000 in 2017. In addition,

• 52% of people with chronic HCV were in the 1945 to 1965 birth cohort*
• 14% of people with chronic HCV were women of childbearing age*
• 4% of people with chronic HCV were people who inject drugs*
• The number of people with chronic HCV in prisons was unknown
• The number of people with chronic HCV in Medicaid was unknown

*Percentages do not sum to 100% because overlap exists across groups, and not all subpopulations are considered here.