Strategies to Increase Primary Care Provider Capacity for Hepatitis C Care: The California ECHO-PLUS Study.

Expanding capacity to screen and treat those infected with the hepatitis C virus (HCV) is an essential element of the global elimination strategy. We evaluated the hub-and-spoke Project ECHO training versus telementoring models to educate, train and support HCV care by primary care providers in 13 targeted counties in northern California. A novel provider engagement strategy was used. Provider engagement and retention, time to readiness to treat HCV, and knowledge and confidence were the outcomes of interest. 94 participants from 60 unique clinics in the target counties participated in the ECHO-PLUS program; 39.4% were physicians, 48.9% advanced practice providers and 11.7% nurses. The median (range) participation time was 5 (1-49) hours. Confidence scores (minimum score = 5 and maximum score 40) increased by a mean of 14.0 (SD:8.2) and 11.4 (SD:12.0) points for the hub-and-spoke and telementoring programs, respectively (p=0.53), with the largest changes in confidence seen in treating patients per guidelines, managing side effects and in serving as a consultant for HCV in their clinic. Among 24 participants with data on time to treatment, median time from beginner to experienced was 8 hours (IQR:6-12) for hub-and-spoke and 2 hours (IQR:1-2.4) for the telementoring program (p=0.01).A "boots on the ground" approach was effective in recruiting HCV champions within rural communities. Both tele-ECHO hub-and-spoke and telementoring approaches to training primary care providers yields increase in knowledge and confidence in HCV care and amplifies the number of patients who were screened and treated. Telementoring accelerates the timeline of novice providers being "ready to treat".