Health. This program aims to increase the number of inmates who are aware of their HCV status
prior to being released into the general population. Inmates due for release from corrections are
tested using rapid HCV test kits. All inmates with a positive rapid HCV result and those known to be
HCV positive are linked to clinical providers in their respective communities.
Strategy 3.2: Increase health care provider capacity to screen and treat hepatitis C in both
rural and urban settings.
The burden of HCV disease far outstrips the capacity to treat expeditiously. More providers must be
engaged to treat HCV in their practices. This means moving beyond specialist-only treatment.
Studies have found no significant difference in sustained virologic response (SVR) among patients
treated with direct acting antiviral (DAA) therapy prescribed by non-specialists versus specialists.
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By engaging both specialists and non-specialists in HCV treatment, the state’s overall capacity to
cure HCV infection can be increased.
To increase the availability of HCV care in Maryland, health care providers throughout the state have
taken the initiative to integrate HCV services into their practices or expand their HCV patient panel
size to facilitate increased treatment access. To meet this need, the Department established the
Maryland Community-based Programs to Test and Cure Hepatitis C (“Test and Cure Program”)
through a CDC grant totaling $1.2 million. This four-year cooperative agreement with CDC supports
a multi-pronged approach to clinical integration of HCV testing, care, and treatment at health care
settings in Baltimore City, Baltimore County, Montgomery County, and Prince George’s County,
which are the Maryland counties with the highest prevalence of HCV. This work has revealed the
substantial infrastructure and coordination necessary to implement and maintain high quality HCV
service delivery. Additionally, it has demonstrated the need to develop clinical expertise related to
HCV screening, care and treatment in community-based health care centers. Most importantly, it has
increased the availability of HCV care in settings where individuals in the state’s highest burden
jurisdictions already access health care and other services. The Maryland Primary Care Program, an
essential element of the State’s Total Cost of Care Model,
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launched in 2018 and will include
primary care providers from across the state who could be part of these efforts to increase integration
of comprehensive HCV care into their practices. Governor Hogan’s Fiscal Year 2020 budget
allowance includes state funds to continue the HCV surveillance after the CDC funding ends.
In 2015, the Johns Hopkins University, in collaboration with the Maryland Department of Health,
launched a comprehensive clinical hepatitis C training and certification program for primary care
providers in Baltimore City and Baltimore County. Titled Sharing the Cure, the HCV training and
certification program for clinicians (physicians, physicians assistants, and nurse practitioners) was
modeled after the University of New Mexico’s Project ECHO (Extension for Community Healthcare
Outcomes), clinicians from the participating clinical sites receive HCV certification upon completion
of a one-day intensive training, a half-day preceptorship at an HCV specialty clinic, and ongoing
videoconference training by leading specialists. Additionally, the training addresses the need for
improved cultural competency of providers to care for the key populations noted in Strategy 3.1.
Provider training in conjunction with developing internal clinical infrastructure to support HCV
services is leading to the overall aims of increased screening and treatment at participating clinics.
The program’s success is evidenced not only by staff outreach to over 1,600 people for HCV linkage
to care and over 5,000 patients seen by trained providers, but also by interest in the training that
surpasses the program’s current capacity and requests from specialists and other medical
professionals (e.g., pharmacists) seeking to participate in the training program. In 2019, the training
program will expand to include clinicians who provide Ryan White HIV/AIDS services throughout