An estimated three million Americans, including 70,000 Chicago residents, are living with HCV infection. Approximately half are unaware of the infection. While this blood-borne infection can progress slowly, it can cause severe liver damage and, in some cases, death. Hepatitis C is the leading cause for liver transplants.
To address this growing issue in Chicago, the Centers for Disease Control and Prevention has awarded the Extension for Community Healthcare Outcomes Chicago (ECHO-Chicago) program at the University of Chicago Medicine $1.55 million grant from to lead an unprecedented public health collaboration to reduce hepatitis C (HCV) infections in Chicago. The total projected grant of $6.2 million over four years will fund the Hepatitis C Community Alliance to Test and Treat (HepCCATT) program to build Chicago’s capacity to test for and cure HCV infections.
The program brings together leading academic medical centers, community health providers, corporate partners and advocacy groups in collaboration with the Illinois Department of Public Health (IDPH) and the Chicago Department of Public Health (CDPH).
HepCCATT focuses on four key areas:
- Public education on hepatitis C risk factors and importance of testing
- Expand primary care provider (PCP) capacity to treat, and cure HCV at community health centers
- Robust surveillance to monitor population-level changes in HCV testing, treatment, and cure
- Coordination among all stakeholders to improve access and reduce the cost of HCV care.
Under the leadership of ECHO-Chicago director and founder Daniel Johnson, MD, section chief of academic pediatrics and associate professor of pediatrics at UChicago Medicine, this city-wide collaboration includes IDPH, CDPH, Alliance of Chicago, American Liver Foundation — Great Lakes Division, BioCure Specialty Pharmacy, Caring Ambassadors Program Inc., Medical Research Analytics and Informatics Alliance, Northwestern Medicine, University of Illinois at Chicago, and Walgreens. A network of at least 288 PCPs at 30 Chicago community health centers will participate in ECHO-Chicago training over the four-year grant period. A group of at least eight HCV experts and advocates will serve as an external advisory board.
“We’re thrilled to have CDC’s support of this groundbreaking effort to reach Chicagoans infected with HCV and link them to appropriate care — particularly in this period of tremendous progress in well-tolerated, curative therapies,” said Johnson. “The promise of this initiative lies in its dynamic, cross-sector collaboration, leveraging the strengths of each partner. ECHO-Chicago is pleased to lend its extensive community health network and valuable insight on health care capacity building.”
“This is groundbreaking. This will become the template to track any disease process.” — Daniel Johnson, MD, to the Chicago Tribune
Beginning this fall, HepCCATT will implement a suite of coordinated interventions aimed at Chicago populations with HCV-related health disparities, including people born between 1945 and 1965, African-Americans, and current and former intravenous drug users. The initiative has set ambitious goals: screening for 18,500 people each year, with 2,500 people treated and cured.
Under HepCCATT, ECHO-Chicago will lead efforts to increase significantly the number of community-based primary care providers trained to diagnose and treat HCV, particularly in underserved communities. The physcians will participate in a case-based, interactive telehealth training curriculum developed by leading HCV expert Andrew Aronsohn, MD, co-principle investigator for HepCCATT. Aronsohn is a hepatologist at UChicago Medicine and a panel member for HCV guidance for the American Association for the Study of Liver Diseases and the Infectious Disease Society of America.
High tech videoconference systems will allow PCPs to engage in case review and discussion similar to medical rounds, a standard in academic medical centers. The approach offers participants the opportunity to learn from a respected specialist and from each other about best practices in HCV prevention, screening and treatment tailored for community, primary care settings. The ECHO model has demonstrated effectiveness in the treatment of HCV. A clinical trial of patients treated in a subspecialty clinic at University of New Mexico Hospital (UNMH) and patients treated via an ECHO-trained PCP showed no significant difference in outcomes, including cure.
Several HepCCATT partners will coordinate grassroots public education efforts, targeting community-based organizations, churches and other safety net service providers. Organizers also plan to use social media and community events to increase awareness and promote testing.
The Community Outreach Intervention Program (COIP) at University of Illinois at Chicago will use their highly regarded case management protocol to deliver services that reduce barriers to treatment, such as transportation, medical insurance, drug abuse treatment and financial assistance programs. Case managers will link HCV-infected individuals to affordable, accessible, high quality medical care from doctors who have been trained by ECHO-Chicago.
Surveillance is a key component of HepCCATT and will help to ensure follow-up and continuity of care. In collaboration with UChicago Medicine, IDPH, CDPH, the Medical Research Analytics and Informatics Alliance (MRAIA), and the Chicago Health Information Technology Regional Extension Center (CHITREC) at Northwestern University will design, create and implement HepCCATT’s technology infrastructure, linking de-identified clinical data from multiple sources, including Chicago’s major hospitals, community health center partners, and participating pharmacies. The system will enable real-time reporting to CDPH and IDPH on the number of people tested for HCV, the number who test positive, the number receiving treatment, and the number of people cured.
“There are no easy answers to halting the rise in morbidity and mortality from undiagnosed HCV,” said Johnson, “but any potential solution must address the unique needs of high-risk urban populations, bringing them into quality care and keeping them in quality care. We’re proud to be at the forefront of such a forward-looking community health initiative. Our hope is to develop a model that can be replicated in urban settings across the nation.”
About ECHO Chicago
The Extension for Community Healthcare Outcomes Chicago (ECHO-Chicago) was founded at the University of Chicago Medicine in 2010. Pioneered for rural communities by the University of New Mexico, ECHO is an innovative model to train community-based providers to deliver state-of-the-art care for common, chronic diseases in vulnerable, underserved communities. ECHO-Chicago is the first successful replication of the model in an urban setting. Using advanced communication technologies, ECHO-Chicago bridges the gap between disease specialists at a leading academic medical center and providers who deliver comprehensive, culturally relevant, care at neighborhood-based health centers. For more on ECHO-Chicago’s mission and its current curricula, visit http://www.echo-chicago.org/