Background Hepatitis C virus (HCV) disproportionately affects disadvantaged communities. Objective To examine processes and outcomes of Screen, Treat, Or Prevent Hepatocellular Carcinoma (STOP HCC), a multicomponent intervention for HCV screening and care in safety-net primary care practices. Design Mixed-methods retrospective analysis. Setting 5 federally qualified health centers (FQHCs) and 1 family medicine residency program serving low-income communities in diverse locations with largely Hispanic populations. Patients Persons born in 1945 through 1965 (baby boomers) who had never been tested for HCV and were followed through May 2018. Intervention The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model guided implementation and evaluation. Test costs were covered for uninsured patients. Measurements All practices tested patients for anti-HCV antibody (anti-HCV) and HCV RNA. For uninsured patients with chronic HCV in 4 practices, quantitative data also enabled assessment of HCV staging, specialist teleconsultation, direct-acting antiviral (DAA) treatment, and sustained virologic response (SVR). Implementation fidelity and adaptation were assessed qualitatively. Results Anti-HCV screening was done in 13 334 of 27 700 baby boomers (48.1%, varying by practice from 19.8% to 71.3%). Of 695 anti-HCV-positive patients, HCV RNA was tested in 520 (74.8%; 48.9% to 92.9% by practice), and 349 persons (2.6% of those screened) were diagnosed with chronic HCV. In 4 FQHCs, 174 (84.9%) of 205 uninsured patients with chronic HCV had disease staging, 145 (70.7%) had teleconsultation review, 119 (58.0%) were recommended to start DAA therapy, 82 (40.0%) initiated free DAA therapy, 74 (36.1%) completed therapy (27.8% to 60.0% by practice), and 70 (94.6% of DAA completers) achieved SVR. Implementation was promoted by multilevel practice engagement, patient navigation, and anti-HCV screening with reflex HCV RNA testing. Limitation No control practices were included, and data were missing for some variables. Conclusion Despite a similar framework for STOP HCC implementation, performance varied widely across safety-net practices, which may reflect practice engagement as well as infrastructure or cost challenges beyond practice control. Primary Funding Source Cancer Prevention & Research Institute of Texas and Centers for Medicare & Medicaid Services.

中文翻译：

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丙型肝炎病毒的筛查和护理：在为弱势群体服务的初级保健实践中实施的复杂性。

背景丙型肝炎病毒（HCV）严重影响弱势社区。目的探讨筛查，治疗或预防肝细胞癌（STOP HCC）的过程和结果，这是一种在安全网初级保健实践中进行HCV筛查和护理的多组分干预措施。设计混合方法的回顾性分析。设立5个具有联邦资格的医疗中心（FQHC）和1个家庭医学居留计划，为在西班牙裔人口众多的不同地区的低收入社区提供服务。患者1945年至1965年出生的人（婴儿潮时期出生的人）从未接受过HCV测试，直到2018年5月均受到随访。干预达到率，有效性，采用率，实施和维持（RE-AIM）模型指导实施和评估。未投保患者的测试费用已包括在内。测量所有实践均对患者进行了抗HCV抗体（anti-HCV）和HCV RNA的测试。对于4种实践中未投保的慢性HCV患者，定量数据还可以评估HCV分期，专家远程咨询，直接作用抗病毒（DAA）治疗和持续病毒学应答（SVR）。对实施保真度和适应性进行了定性评估。结果在27 700个婴儿潮一代中，有13 334人进行了抗HCV筛查（48.1％，根据实际情况从19.8％到71.3％不等）。在695例抗HCV阳性患者中，有520人（74.8％；实践中为48.9％至92.9％）检测了HCV RNA，并诊断出349人（筛查者为2.6％）。在4个FQHC中，在205名无保险的慢性HCV患者中有174名（84.9％）患有疾病分期，有145名（70.7％）接受了远程咨询检查，建议119名（58.0％）开始进行DAA治疗，82例（40.0％）发起了免费的DAA治疗，74例（36.1％）的完成治疗（实践中为27.8％至60.0％），70例（94.6％的DAA完成者）达到了SVR。通过多层次实践参与，患者导航和具有反射性HCV RNA测试的抗HCV筛选，促进了实施。局限性未包括任何控制措施，并且某些变量的数据丢失。结论尽管STOP HCC实施的框架类似，但安全网实践的绩效差异很大，这可能反映了实践参与以及实践控制之外的基础架构或成本挑战。德克萨斯州癌症预防和研究所以及Medicare和Medicaid服务中心的主要资金来源。6％的DAA完成者获得了SVR。通过多层次实践参与，患者导航和具有反射性HCV RNA测试的抗HCV筛选，促进了实施。局限性未包括任何控制措施，并且某些变量的数据丢失。结论尽管STOP HCC实施的框架类似，但安全网实践的绩效差异很大，这可能反映了实践参与以及实践控制之外的基础架构或成本挑战。德克萨斯州癌症预防和研究所以及医疗保险和医疗补助服务中心的主要资金来源。6％的DAA完成者获得了SVR。通过多层次实践参与，患者导航和具有反射性HCV RNA测试的抗HCV筛选，促进了实施。局限性未包括任何控制措施，某些变量的数据丢失。结论尽管STOP HCC实施的框架类似，但安全网实践的绩效差异很大，这可能反映了实践参与以及实践控制之外的基础架构或成本挑战。德克萨斯州癌症预防和研究所以及Medicare和Medicaid服务中心的主要资金来源。结论尽管STOP HCC实施的框架类似，但安全网实践的绩效差异很大，这可能反映了实践参与以及实践控制之外的基础架构或成本挑战。德克萨斯州癌症预防和研究所以及Medicare和Medicaid服务中心的主要资金来源。结论尽管STOP HCC实施的框架类似，但安全网实践的绩效差异很大，这可能反映了实践参与以及实践控制之外的基础架构或成本挑战。德克萨斯州癌症预防和研究所以及Medicare和Medicaid服务中心的主要资金来源。