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Dale, Cheryl H. MScN, NP-Adult (Provider Solutions Manager - Hepatology)1; Smith, Elizabeth MN, NP-PHC (Primary Care Nurse Practitioner and Nurse Practitioner Clinical Lead)1,2; Biondi, Mia J. PhD, NP-PHC (NP-Researcher)1,3

1Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada,

2Thames Valley Family Health Team, London, Ontario, Canada,

3Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, Ontario, Canada

Correspondence: Mia J. Biondi, PhD, NP-PHC, Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, 200 Elizabeth Street 9EB 240, Toronto, ON M5G 2C4; E-mail: [email protected]

Funding: This study was supported by Specialty Rx Solutions, Gilead Sciences, and the Viral Hepatitis Care Network.

Competing interests: CD reports serving as a speaker, consultant, and advisory board member for Gilead and AbbVie. MJB reports receiving research support and consulting fees from AbbVie, Gilead, and Specialty Rx Solutions. Honorarium for NPs was provided by Specialty Rx Solutions. No other competing interests were declared.

Authors' contributions: C. H. Dale, E. Smith, and M. J. Biondi conceived and designed the study. C. H. Dale and M. J. Biondi were in clinical roles for consultation. C. H. Dale, E. Smith, and M. J. Biondi collaborated on site-specific mechanisms to implement testing, linkage to care, and treatment , retrieved and analyzed the data. Initial and final manuscript preparation was completed by C. H. Dale, E. Smith, and M. J. Biondi, and all have approved the final version to be published and agreed to be accountable for all aspects of the work.

Primary care providers are often the first point of contact for hepatitis C virus (HCV) care, yet treatment initiation in primary care continues to be low. Nurse practitioners (NPs) are autonomous providers who, in Ontario, currently prescribe HCV therapy; however, methods to engage primary care NPs in HCV care have not occurred.

To assess the feasibility of a systematic approach to train and support NPs in HCV testing, care, and treatment .

Nurse practitioners from Canada's largest family health team (FHT) were recruited. Nurse practitioners received six hours of training and develop approaches to screen and treat at FHT sites. Treatment algorithms were given, and the number and types of inquiries from NPs were recorded.

Over 1 year, 9 NPs screened 1,026 patients; 87.4% were screened based on the identification of a risk factor. A mail-out approach for birth cohort screening occurred at a single site, resulting in rapid uptake in screening. Antibody prevalence was 1.66%, with 76.5% RNA positivity. All RNA-positive treatment -eligible individuals were treated by an NP and completed treatment . Thirty-eight consults occurred over 1 year, the majority related to HCV or liver disease staging.

Formalized initiatives to engage and educate NPs lead to innovative strategies to test for HCV. Nurse practitioners can safely and effectively treat HCV in primary care with minimal support.

This work could be extrapolated to NPs in other primary care settings. Implementing formalized strategies has the potential to create NP leaders in the treatment and elimination of HCV in Ontario, Canada, and globally.

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Keywords Hepatitis C virus , models of care , nurse practitioners , primary care , treatment

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