Improving Access to Hepatitis C Care for Urban, Underserved Patients Using a Primary Care-Based Hepatitis C Clinic

Objective: Chronic hepatitis C affects 200 million people worldwide and is a leading cause of death from liver disease. Effective treatment is available but can be difficult to access for uninsured, urban patients. National organizations have called for improving access to hepatitis C care in these groups. We present an innovative model for expanding access to hepatitis C care for urban, underserved patients (The Grady Liver Clinic, Grady Memorial Hospital, Atlanta, Georgia). The liver clinic provides hepatitis C care by general internists in the primary care setting. Methods: We performed a retrospective chart review of all liver clinic patients (n = 807) who presented in the first 5 years of the clinic's operation. Measures included patients' demographic and hepatitis C-related characteristics; prevalence of medical, psychiatric, and substance abuse comorbidities; and treatment status. Results: The liver clinic population is primarily black (76%) and uninsured (59%). Patients had difficult-to-treat characteristics, including genotype 1 hepatitis C (90%), advanced liver fibrosis (28%), and high viral loads. Sixty-seven percent had comorbid medical conditions, and 40% had psychiatric disease. Fourteen percent of patients were treated for hepatitis C during the study period. Conclusion: The liver clinic has proven to be a successful model for improving access to hepatitis C care for urban, underserved patients. Despite having significant hepatic disease and medical and psychiatric comorbidities, patients in the liver clinic can be successfully maintained in care and initiated on hepatitis C treatment by general internists in a primary care setting.