Twice a month, a team of infectious disease specialists gathers in an online forum that connects the specialists with physicians in rural, remote, and underserved communities throughout Texas to educate them on how to treat patients whose medical needs are outside their scope of practice.
Using the teleECHO (Extension for Community Healthcare Outcomes) model, UT Health San Antonio is helping health care providers understand how to treat hepatitis C virus (HCV) in patients with HIV by guiding them through the process and connecting them to necessary resources through its online knowledge-sharing platform.
“People living with HIV have more hepatitis C diagnoses than the general population, and HIV infection accelerates the progression of liver disease in people co-infected with HIV and HCV compared to those with HCV only,” said Dr. Waridibo Allison, assistant professor of infectious disease at UT Health San Antonio. “The virus is curable, yet hepatitis C is the primary cause of liver cancer in the United States, and nearly 400,000 residents of Texas are infected with [HCV].”
Since launching in October, UT Health San Antonio ECHO has hosted seven meetings for health care providers working out of four government-funded HIV/AIDS clinics in southern Texas: Coastal Bend Wellness Center in Corpus Christi, PILLAR in Laredo, Valley AIDS Council serving Brownsville, Harlingen, and McAllen, and the San Antonio AIDS Foundation.
“We educate primary care physicians so that they can go back to their patient and provide specialty-level care in areas where it might be difficult, or even impossible, for someone to get to their closest specialist,” Allison said. “Studies show that with the right training, primary care physicians can deliver treatment for hepatitis C just as effectively as if they were an infectious disease specialist or hepatologist.”
On the second Wednesday and fourth Friday of each month, physicians dial in to a telehealth conference where they first listen to an education module, then present patient symptoms and complications, and receive feedback on how proceed with treatment. The team of specialists lending their expertise includes hepatologists, psychiatrists, pharmacists, community health workers, and gastroenterologists from San Antonio and Austin.
Dr. Dora Martinez, family physician and chief medical officer of the Westbrook Clinic in Harlingen, told the Rivard Report that the medically underserved area where the clinic is located has only four gastroenterologists, which can make seeing a specialist difficult.
“For some patients in the area, they might be waiting a year to get in to see the [gastroenterologist],” and depending on the type of insurance they have, it might take even longer, Martinez said. “If I have a patient who needs to be treated for hepatitis C, I will need advice from an infectious disease specialist or hepatologist, and I have access to all of that in an ECHO session.”
At the end of the session, physicians walk away with a full treatment plan to follow that outlines exactly what they need to do, from the amount of medication to prescribe to side effects to look out for, and is accepted as expert consultation needed for insurance reimbursements and prescribing medication.
In addition to discussing treatment approaches, the providers who call in to the ECHO session receive advice on how to work with Medicaid, commercial, or state insurance from people with experience navigating those systems and “working around the red tape,” Martinez said.
The Westbrook Clinic is the primary provider of HIV prevention, education, and testing services in a three-county area along the Rio Grande Valley. While services for this population are available, seeing a specialist depends on availability, and in many cases, accessing this care is not possible due to transportation issues.
Martinez said that where she used to work, in Santa Rosa, she was the only doctor in the city.
“Sometimes these folks have no transportation, and most walked to my clinic for their appointment. It would be a 45-minute drive to the next city to see a specialist, and they don’t have a car. These are the patients who benefit the most from what the ECHO program has to offer.”
UT Health San Antonio ECHO is made possible through a three-year, $6.4 million federal grant awarded to Allison by the U.S. Department of Health and Human Services to study hepatitis C in people of color living with HIV. It falls under the umbrella of Special Projects of National Significance.
Southern states including Texas account for 44 percent of new diagnoses of HIV while containing only 37 percent of the country’s total population, according to the Centers for Disease Control and Prevention. Texas Health and Human Services Commission data show that of new HIV diagnoses in Laredo, 98 percent of the patients were Hispanic; in San Antonio, 65 percent were Hispanic.
Allison said these statistics make the issue of HCV and HIV in minority populations “incredibly significant.”
“As an infectious disease specialist, my primary interest is access to care for marginalized populations,” Allison said. “There are lots of people who need to have hepatitis C treated, and [the ECHO program] helps us to be able to reach those patients who need it the most.”
A 52-year old male, who requested to remain anonymous, found out he was infected with HIV six years ago and soon learned he also had HCV. After years of struggling to find a primary care physician to treat his conditions, he connected with Allison last summer and immediately began medication for both HCV and HIV.
“I was not in very good shape because I couldn’t find anyone to treat me, but since I got on the medication I have been doing really well,” he said. “After I had only been on the meds for a month, I was told my [hepatitis C viral load count] was undetectable, and since then I have gained weight and I feel fantastic. I’m in great health now. I have had friends that I watched die because they weren’t getting treated, and sometimes that was simply because they couldn’t find a doctor who could work with them.”
Allison said the UT Health San Antonio ECHO program hopes to expand beyond just working with people who have HIV and HCV.
“The ECHO program has support at the federal level, so we are hopeful that we can sustain our program beyond the three-year grant period so we can continue to build community and empower physicians to provide specialist care all over the world.”