Reinfection or Relapse: Retreating Patients for HCV

August 17, 2021

There is no cost to attend. Sessions are the third Tuesday of the month. 

The HCV ECHO is a tele-mentoring program that uses videoconferencing technology (Zoom) to combine MAT didactic presentations with interactive and practical HCV case presentations from participants.

To register, email the following information: Name, title, credentials, organization name, and email address.

Target Audience

Providers and clinical staff who are interested in providing treatment and care to individuals diagnosed with Hepatitis C (providers, nursing, behavioral health, linkage navigators, front desk/scheduling, admin, etc.).

Learning Objectives

  • Diagnose, manage, and treat patients with Hepatitis C.
  • Discuss risk factors for reinfection or relapse of HCV.
  • Identify best practices to prevent reinfection and relapse of HCV.

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 liver-related death. HCV is often known as a “silent disease,” as there are 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). Prior to 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 liverrelated 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 now 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 numbers 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 US, particularly among people with a history of injection drug use. The U.S. experienced marked increases in hospital admissions for acute HCV and for 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 (VA) 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 combined with increased methamphetamine usage in some parts of the country present new challenges for HCV prevention efforts. At present, policies to prevent transmission among drug users are entirely state-specific, and in many states, these policies simply 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. There were an estimated 870 people acquiring HCV annually, 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 child bearing 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.

    Course summary
    Available credit: 
    • 1.50 AMA PRA Category 1 Credits
    • 1.50 AOA Category 2­A
    • 1.50 CE Contact Hour(s)
    • 1.50 IBON
    Course opens: 
    Course expires: 
    Event starts: 
    08/17/2021 - 11:45am CDT
    Event ends: 
    08/17/2021 - 1:15pm CDT
    11:45 am

    Didactic Sessions

    Topics may include: 

    • Hepatitis C 101
    • HCV Treatment medications and access to treatment
    • Treatment Considerations for People Living with HCV (re-infection; Genotyping; people who use substances; necessary lab work; etc.)
    • Health Economics 101: Standard v. Enhanced Screening and Treatment
    • Drug User Health and Person-Centered Language
    • Treating Patients with Substance Use Disorders and HCV
    • Co-Infections: HIV and HCV
    • Populations Disproportionately Impacted by HCV and/or HIV (LGBTQ+; Persons experiencing human trafficking and Intimate Partner Violence; racial and ethnic groups)
    • HCV Screening among pregnant women
    12:30 pm

    Case Presentations

    You do not need to present a case during every session in order to participate in the HCV clinic. However, the submission of cases for presentation and discussion is a key component in the Project ECHO model and critically important for knowledge building and sharing, and it is therefore required that each provider present at minimum three cases per year. We welcome cases that involve common clinical scenarios related to HCV diagnosis and care as well as difficult, complex, or challenging presentations and patient management scenarios.


    Divya Ahuja, MD
    Clinical Associate Professor of Internal Medicine, University of South Carolina School of Medicine

    Dr. Ahuja graduated medical school in New Delhi, India in 1992, and completed parts of his residency in India , the United Kingdom and then at York Hospital in Pennsylvania. Dr. Ahuja also trained in a fellowship in Genitourinary Medicine and HIV at the Bristol Royal Infirmary and Plymouth Hospital in the United Kingdom and then completed a fellowship in Infectious Disease at Penn State University College of Medicine in 2005. He is the Principal Investigator for the SC HIV/HCV Clinical Training Center and the South East HCV Telehealth Initiative, as well as the Medical Director of the Immunology Center.

    Hepatitis C ECHO Team

    Donald Hillebrand, MD attended Iowa State University as an undergraduate and medical school at the University of Iowa’s College of Medicine. He completed his internship/residency with the University of Iowa Hospitals and Clinics Internal Medicine Division with a Fellowship in Gastroenterology-Hepatology. He is board certified in GI/Hepatology and Transplant Hepatology by the American Board of Internal Medicine and is an Adjunct Clinical Assistant Professor of Internal Medicine, Des Moines University College of Osteopathic Medicine and the Medical Director of the UnityPoint Health Center for Liver Disease in Des Moines with Outreach Clinics in Grinnell, Osceola, Nevada, Boone and Fort Dodge. He has been managing Hepatitis C since the early 1990’s. He is the lead hepatology expert for this ECHO program.

    Megan Srinivas, MD, MPH is a board certified in infectious disease by the American Board of Internal Medicine. Dr. Srinivas received both her undergraduate and MPH degrees from Harvard, her medical degree from University of Iowa’s Carver College of Medicine, and completed her residency training from Johns Hopkins. She will serve as an infectious disease expert for HCV ECHO program.

    Steven Donnelly, PharmD, is a specialty pharmacist at Community, A Walgreens Specialty Pharmacy in Des Moines, Iowa. Dr. Donnelly is the lead pharmacy expert for the HCV ECHO program.

    Mark Hillenbrand, LISW, RCSW, conducts psychotherapy with individuals, couples, families, and groups at his private practice, Authentic Freedom, in Des Moines, Iowa. He is trained in self-psychology, object relations, and pastoral counseling. Mark specializes in assisting individuals diagnosed with chronic and traumatic illness, to identify and take steps in continuing their journey of leading health lives. Mark has extensive experience in working with individuals diagnosed with HIV/AIDS, HCV, Huntington’s Disease and other significant health diagnoses.

    Julie Baker, MPH, CHCEF, is the Director of Clinical Consulting at the Iowa PCA providing training, technical assistance, and program development focused around HIV, Hepatitis and STDs, and related areas. Julie serves as the ECHO Program Coordinator for the HCV ECHO program.

    Gagandeep Lamba, MA, MS, MBA, CSM, is a Behavioral Health Consultant at Iowa PCA providing training, technical assistance, and quality improvement support to Iowa’s health centers. Gagan will assist with the ECHO program coordination.

    Alicia Huguelet, MPH, MSW, is the Senior Director of Transformation at Iowa PCA leading the performance improvement team in their work to assist health centers in implement process change, developing and strengthening programming and data tools to better manage work support programs.

    Sarah Dixon, MPA, is the Senior Director for Partnerships and Development at the Iowa PCA. Sarah leads the development work and emerging programs for the PCA, many of which specifically focus on vulnerable populations, innovative partnerships and programming related to social determinants of health and assisting the health centers in Iowa to better connect to the needs of the communities they serve.

    Kristi Roose, BA, CPHIMS, is the Senior Director of Technology at the Iowa PCA where she supports technology operations for the statewide INConcertCare Health Information Technology Network. Kristi has over 20 years experience in Information Technology including 10+ years in Health Information Technology. Kristi is a Certified Professional of Health Information & Management Systems and received a Bachelor of Science degree in Management Information Systems and Finance from Iowa State University.

    Liz Noble is the Administrative Assistant for the Iowa PCA. Liz will be providing assistance with administrative support for the Iowa PCA ECHOs. She graduated from Iowa State University with a Bachelor of Science in Financial Counseling and Planning in May 2020.

    Accreditation Statements

    • MD:  This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Iowa Medical Society (IMS) through the joint providership of Des Moines University (DMU) and the Iowa Primary Care Association. DMU is accredited by IMS to provide continuing medical education for physicians. DMU designates this live, online activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.
    • DO: Des Moines University (DMU) is accredited by the American Osteopathic Association (AOA) to provide osteopathic continuing medical education for physicians. DMU designates this program for a maximum of 1.5 AOA Category 2-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.
    • Nurse: Des Moines University is Iowa Board of Nursing approved provider #112. This live activity has been reviewed and approved for 1.5 continuing education contact hour(s). No partial credit awarded.
    • Other Healthcare Professionals: This live activity is designated for a maximum of 1.5 AMA PRA Category 1 Credit(s)™.


    No commercial interest company provided financial support for this continuing education activity.


    Relevant to the content of this educational activity, the following individuals have no conflicts of interest with commercial interest companies to disclose.

    • Julie Baker, MPH, CHCEF - Planning Committee Member and Moderator
    • Sarah Dixon, MPA - Planning Committee Member
    • Steven Donnelly, PharmD - Planning Committee Member
    • Alicia Huguelet, MPH, MSW - Planning Committee Member
    • Gagandeep Lamba, MA, MS, MBA, CSM - Activity Planning Committee Member
    • Bethany Maen - Planning Committee Member
    • Chelsea Miller - Planning Committee Member
    • Liz Noble - Planning Committee Member
    • Kristi Roose, BA, CPHIMS - Planning Committee Member
    • Megan Srinivas, MD, MPH - Planning Committee Member
    • Megan Westerly, MSN, BA, RN - Moderator

    Relevant to the content of this educational activity, the following individual(s) have a conflict(s) with commercial interest companies to disclose.

    • Donald Hillebrand, MD - Planning Committee Member, Speaker’s bureau for AbbVie and Gilead 
    • Mark Hillenbrand, LISW, RCSW - Planning Committee Member, Spouse is an employee at Vida Health (develops health information material for consumers)
    • Divya Ahuja, MD - Speaker, Does not have a relationship to disclose but does intend to discuss an off-label use of a product or device

    The speaker(s) will disclose if any pharmaceuticals or medical procedures and devices discussed are investigational or unapproved for use by the U.S. Food and Drug Administration (FDA). Determination of educational content and the selection of speakers is the responsibility of the activity director. 


    The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. The content of each presentation does not necessarily reflect the views of Des Moines University.

    Available Credit

    • 1.50 AMA PRA Category 1 Credits
    • 1.50 AOA Category 2­A
    • 1.50 CE Contact Hour(s)
    • 1.50 IBON


    Please login or Create an Account to take this course.

    There is no cost to attend. Sessions are the third Tuesday of the month. 

    The HCV ECHO is a tele-mentoring program that uses videoconferencing technology (Zoom) to combine MAT didactic presentations with interactive and practical HCV case presentations from participants.

    To register, email the following information: Name, title, credentials, organization name, and email address.