TROSA Health Clinic Providers Publish Innovative Case Study

In the May 2022 publication of the NEJM Catalyst Innovations in Care Delivery, a team of primary care providers share how they developed and implemented a successful Hepatitis C virus (HCV) treatment model for TROSA residents—a group model that may be beneficial in primary care settings serving patients in other substance use disorder treatment programs.

The following is a summary from the case study’s report “Treating Hepatitis C in a Substance Use Recovery Program: A Limited-Resource Group Model.”

The NEJM Catalyst case study authors were TROSA primary care providers Quinnette B. Jones, MSW, LCSW, MHS, PA-C; Kristi Giemza, MSN, RN, FNP-BC; Lorraine Anglin, MHS, PA-C; and Sarah Cottingham, MSN, RN, FNP-BC.

Case Study Summary

Hepatitis C virus (HCV) infections are increasing among people with injection drug use. Access to HCV treatment for people with substance use disorders is challenging at the individual, societal, and systemic levels, and innovative treatment models must address these challenges.

Unfortunately, people with substance use disorders are less likely to receive screening or treatment for HCV. People who inject drugs experience stigma and discrimination in health care settings, which create barriers to receiving care.

The cost of treatment is another barrier, particularly for those who are uninsured, live in a rural or remote area, or lack stable housing.

TROSA’s residents are largely uninsured. In 2020-2021, 86% of residents did not have health insurance. As part of TROSA’s comprehensive recovery program, we provide access to on-campus primary care that is cost-free for our residents, thanks to a health clinic established in partnership with providers from the Duke School of Nursing and Duke Physician Assistants Program.

In their innovative study and treatment plan, TROSA’s campus clinic primary care providers sought to develop a sustainable model for treatment of HCV for a primarily uninsured patient population in a substance use recovery program (TROSA’s residents) with limited resources.

Our primary care providers received specialized training and mentorship to care for and treat patients with HCV through the Carolina Hepatitis Academic Mentorship Program (CHAMP). The clinic developed a four-session group treatment model to provide treatment efficiently, with limited resources.

Through the use of patient assistance programs and the clinic’s group protocol, 110 patients receiving substance use treatment were treated and cured of their HCV.

TROSA residents described their HCV treatment as a meaningful step in their recovery. The group model allows for additional time to provide HCV education and dispel myths around HCV acquisition, treatment, and risk of reinfection. Patient and provider feedback indicates that the model worked well to promote engagement between patients and providers, destigmatize HCV, and provide peer support, self-efficacy, and patient education.

The case study authors share that the key to the success of this program was to engage all stakeholders within the organization as well as in the local community.

Through the CHAMP program, connections were made with local/state public health, liver disease, and infectious disease experts who guided creation of the treatment protocol, informed us of local grant initiatives that could aid in providing funding for testing, and provided patient education for group medical visits.

Partnerships with other agencies reduced barriers to accessing care and allowed this program to flourish. TROSA’s providers thank the CHAMP mentors, Drs. Jama Darling and Andrew Muir, for their teaching and mentorship; Dr. Heidi Swygard of Department of Health and Human Services’ Division of Public Health for her collaboration in developing a limited-resource protocol; and LabCorp, the Durham County Department of Public Health, and the Alliance of AIDS Services–Carolina for their ongoing support.

And TROSA’s residents and staff thank our innovative and dedicated primary care providers for their important work. TROSA’s recovery program relies on connection and community…and our providers are a vital part of our community. Together, we are empowering our residents to rebuild healthy lives. Thank you!

About NEJM Catalyst Innovations in Care Delivery: NEJM Catalyst brings health care executives, clinical leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery. Launched in January 2020, the peer-reviewed Catalyst Innovations in Care Delivery journal maintains the original NEJM Catalyst mission to inspire change and impactful innovations. The journal connects clinical leaders, health care executives, clinicians, and academics with the most important ideas and practical solutions for health care delivery through selective, curated content featuring real-world examples and actionable solutions from thought leaders and industry experts on the transformation of health care.