Elaine A. Engelsman, DNP FNP-BC
Trinity Health Muskegon
Practice Address: 1675 Leahy, Suite 301A, Muskegon, MI 49442
Provider Subspecialty: Infectious Disease
Supplemental Services Offered: HIV/PrEP
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Trinity Health Muskegon team. Pictured from left to right: Tiffany Keur, MA; Elaine Engelsman, DNP FNP-BC; Sarah Comp, PharmD; Stephanie Pier, RN, BSN
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Please share your successes and barriers to testing and treating of hepatitis C.
Initially, when we hit 500 cures we thought "WOW" look how far we've come and we made the local news. Now, since passing 1,000 cures, we are looking to hit 1,500 by mid-2024. We are struggling to get patients to complete their final HCV RNA three months after treatment. We could likely take credit for an additional 100 cures.
We continue to encourage our local primary care and specialty practice providers to screen for HCV with the newer recommendations, but we still receive consults for baby boomers stating they are just now finding out they have HCV and many times because of evaluating elevated liver enzymes; not just routinely. We are also trying to get the word out to continue screening every six months for those who are at risk.
Trinity Health's willingness to purchase a Fibroscan in 2016 for our dedicated Muskegon clinic vastly helped us identify who was eligible for HCV treatment prior to the We Treat Hep C Initiative. It was heartbreaking to tell people they were not eligible for treatment because of Medicaid criteria. Many of them had waited months for a consultation.
What is something you'd like to share with other providers who may not yet be testing and treating their patients for hepatitis C?
We are poised to be part of history in eradicating hepatitis C completely. The only way that will occur is to screen everyone over 18 years old to help reduce the estimated 40% of those infected not knowing their diagnoses. Also, encourage the non-specialty providers to pick up the torch and start treating. Mentorships are available with those of us who treat hepatitis C routinely.
"We are poised to be part of history in eradicating hepatitis C completely."
Please share a testimonial on the ease of treating patients for hepatitis C.
I have been in the care of treating hepatitis C since 1998: initially as an RN case manager and then as a nurse practitioner in a gastrointestinal office. In 2011, I developed and initiated the Dedicated Hepatitis C Treatment Clinic in Muskegon. The early days of treating hepatitis C were daunting with navigating 24-48 weeks of interferon and ribavirin-based treatment regimens. The success rates were terrible and side effect profiles were abysmal. Most patients could never complete their course of treatment.
It was amazing to have the first generation of all-oral treatments available even if pill burden, food requirements and side effects were still an issue. Now, being able to cure someone of their hepatitis C in a short 8-12 weeks with very high success rates and few side effects has been a game changer. The clinic now can manage so many more individuals on treatment at one time.
Our treatment protocols have morphed over time to now having fewer follow-ups and required monitoring labs and also using virtual visits more frequently. The biggest change has been We Treat Hep C: the lifting of specialty provider limitations, sobriety requirements, fibrosis score and the required prior authorization has completely changed how we do our work. The process is streamlined and the barriers to treatment are significantly reduced leading to more people on HCV treatment.
"Now, being able to cure someone of their hepatitis C in a short 8-12 weeks with very high success rates and few side effects has been a game changer."
Please share any final thoughts or takeaways.
I have spent a great deal of time and passion trying to champion hepatitis C related services: participated on the state hepatitis task force; advocated for changes in policy with the pharmacy and therapeutics committee at the state; presented podium and poster presentations at a variety of conferences and speaker boards to spread the word about the new screening guidelines and treatment agents, and given lectures to groups of primary care providers about changes in screening recommendations. I am just one advanced practice provider trying to make a difference for this population of patients. There are minimal reasons why screening should not be done with reminders in our electronic medical records. Let's help Michigan be one of the first to hit HCV eradication goals!
Contact Elaine: Elaine.Engelsman@Trinity-Health.org
Adult Universal Hep C Testing Recommendations
CDC recommends hepatitis C testing for:
- Every person ages 18+.
- All pregnant people during every pregnancy.
- Every person with risk factors (at least once and periodically if risk factors are ongoing).
- Any person who requests it, regardless of disclosure of risk.
CDC Recommends Single-Visit Sample Collection to Avoid Incomplete Hepatitis C Testing
A two-step testing sequence (HCV antibody, followed by an HCV RNA test) is recommended for diagnosing hepatitis C infection. However, when an HCV antibody test is reactive and an HCV RNA test is not performed, testing is considered incomplete. Historically, one third of patients have incomplete testing.
Therefore, the CDC has released new operational guidance for completing hepatitis C testing. The new guidance supports strategies that collect samples at a single visit, and automatic HCV RNA testing on all HCV antibody reactive samples. The use of strategies that require multiple visits to collect samples should be discontinued.
By performing automatic HCV RNA testing on all samples reactive for HCV antibodies, the percentage of patients with current HCV infection who are linked to care and receive curative antiviral treatment will increase.
For more information, please review the Morbidity and Mortality Weekly Report.
Additional Hepatitis C Testing Resources
Henry Ford Hepatitis C Clinical Consultation Program - Free consultation line available Monday-Friday 8 a.m. - 5 p.m. for all health care professionals with questions about hepatitis C disease management and treatment 313-575-0332.
MATEC Michigan - Free hepatitis C case-based office hours available for all health care professionals. To request an appointment with a physician specialized in HCV, please call 313-962-2000. For urgent questions, including after hours and on weekends, call 313-408-3483.
Michigan Opioid Collaborative - Free biweekly education and case consultation on hepatitis C to support primary care and community providers with diagnosis, treatment planning, and medication management of people living with hepatitis C.
Michigan State University & Michigan Center for Rural Health - Assist providers and members of the health care team throughout Northern Michigan and the Upper Peninsula to manage infectious disease patients more effectively and confidently through Project ECHO model. Free CME available.
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