RESEARCH POSTER PRESENTATION DESIGN © 2012

www.PosterPresentations.com

• Approximately 2.7-3.9 million people are living with

chronic HCV, which is a leading cause of cirrhosis and

liver cancer and the most common reason for liver

transplantation in the US

• 70-80% of people with acute HCV do not have any

symptoms

• 75-85% of people who become infected with HCV will

develop chronic infection

• Approximately 19,000 people die every year from HCV-

related liver disease.

• In 2014, direct-acting antivirals (DAAs) for the

treatment of HCV were introduced and a new era of

short duration, non-toxic, highly effective, all-oral HCV

regimens emerged as compared to interferon based

therapies.

BACKGROUND

Question

Results

ACKNOWLEDGMENTS

Center for AIDS Research

Jordan White

Generation Tomorrow

Dr. Risha Irvin

Zackiya Grant

JHH ED

Danielle Signer

Tekiya Shabazz

Lucas Spaeth

Sisters Together and Reaching

Reverend Debra Hickman

Donald Brown

Will Fenwick

“ Mr. OD”

REFERENCES

Katerina Lescouflair, Zackiya Grant, Jordan White, Risha Irvin

Patient and Provider Perspectives on Linkage to Care

METHODS

Testing:

• Conducting a finger-prick test and causing someone pain really frightened me at first. However, after some time at STAR

and the JHH ED, I realized a tiny bit of pain was in no comparison to potentially saving someone’s life if they were

previously undiagnosed.

Counseling:

• Working at the ED really taught me how to deal with the emotional dispositions of patients (varying from friendly to irate)

and help educate/counsel them about HIV prevention & infection at the same time. During my time with STAR, I was very

moved by the impact I made with some patients in just fifteen minutes with them. The information shared and

compassion given to the Baltimore City community through STAR is very needed and the open, non-judgmental approach

the Outreach Workers and I utilized is very successful with the people who walk in for testing.

Lessons Learned:

• Through my experience as an intern, I learned that Generation Tomorrow is truly dedicated to the people of Baltimore

City and that if others adopt the same compassion, non-judgmental “meet patients where they are at” attitude, a lot of

health disparities could be eradicated very quickly.

PERSONAL CHALLENGES AND SUCCESSES

FIELD EXPERIENCE & TRAINING• The ultimate goal of this internship was to gain hands-on field experience by working closely with the Baltimore City

community. I joined STAR’s Mobile Testing (HIV/HCV) Van Outreach Program on Thursday nights at “The Block” (and

other destinations around Baltimore) and the JHH ED HIV Research Team multiple days throughout the week. During

that time, I had the privilege to test, counsel, and educate several people.

• Generation Tomorrow provided funding for me to attend an HIV testing and counseling training and certification program

at the University of Maryland Shady Grove.

• Training consisted of a three-day intensive course designed to teach pre- and post-test counseling skills through lectures

and role-play activities. Students then gained hands on experience by conducting closely monitored oral (OraQuick) and

finger prick (Clearview) rapid HIV tests on one another.

• The certification provided to me by the Maryland Department of Health and Mental Hygiene allows me to legally perform

rapid HIV/HCV testing anywhere in Maryland State so long as I receive a unique counselor number for each potential

testing site.

• What barriers to linkage to care currently exist

in the era of DAAs?

1. Document what currently happens to get HCV patients

linked to care

– Met with LTC Coordinators at the Johns Hopkins

Hospital (JHH) Viral Hepatitis Clinic (VHC) at

Blalock and at the JHH Emergency Department

2. Conduct in-depth interviews (IDIs) with patients and

providers (case managers, clinicians, outreach specialists

from Sisters Together and Reaching (STAR) and at the JHH

VHC) to define any barriers to LTC and possible solutions

Diagram courtesy of Yehia et al. Hepatitis C Virus Infection in the United States

CONCLUSIONS

• Educating the public about HCV on a larger scale so

that people have more knowledge around HCV is

crucial. Top priorities in this area should include

modes of transmission, the impact of hepatitis C on

the liver, and treatment options.

• Enacting insurance policy reform: We must increase

advocacy and awareness around insurance covering

medications for all with hepatitis C.

• Ending stigma around HCV is important. By

normalizing HCV testing and increasing education

among the public, we can hopefully decrease any

stigma associated with HCV.

• Do not know risks of untreated HCV or how it can affect the body

• Fear that the disease will mean putting one’s life on hold: work, romantic relationships, substance abuse

• Skepticism and distrust of DAAs

Perception

• Including, but not limited to: homelessness, transient housing, distance/inconsistent transportation to clinic, disconnected phone number, incarceration/prison, substance abuse, food issues, relationship issues (esp. domestic abuse), highly stressful jobs that do not enable patient to make appointments and stay in regular HCV care conflicting medical comorbidities

External Factors

• Fear that insurance companies will not cover the cost of the HCV medical treatment/lack on insurance

Cost

• Shame about diagnosis

• Denial about what will happen if HCV goes untreated

• “I feel okay right now, so the disease isn’t bothering me, and if I mess with it, I’ll make things worse.”

State of Mind

• Do not want friends or family to see them visiting clinic or taking their medication

• Fear of being isolated from family & friends

Privacy

Figure 1: Barriers identified by patients and providers in IDIs. N=9.

Not emotionally or mentally

ready to start

treatment

External factors

A sense of hopelessness

Figure 2: Main reasons providers mentioned patients are lost to care.

Centers for Disease Control and Prevention (CDC). (2016,

May 23). Viral Hepatitis- Hepatitis C Information. Retrieved

July 29, 2016, from Centers for Disease Control and

Prevention (CDC):

http://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ11