In the latest installment of our occasional conversations with Fort Worth newsmakers, Dr. Wari Allison, vice president of health policy at The University of North Texas Health Science Center, discusses the launch of a new app meant to educate providers about patients with both HIV and Hepatitis C.
This conversation has been edited for length and clarity. For an unabridged version, please listen to the audio file attached to this article.
Alexis Allison: Dr. Allison, can we just start with some of the basics? Why are hepatitis C and HIV a pair, especially when it comes to people of color?
Dr. Wari Allison: Hepatitis C and HIV together are what’s called a ‘syndemic.’ There are different definitions for syndemic. But the one that I like is one that was in a 2017 Lancet editorial, and it defines a syndemic as ‘two or more disease states that adversely interact with each other, negatively affecting the mutual costs of each disease trajectory, enhancing vulnerability, and which are made more deleterious by experienced inequities.’
People of color experience inequities related to both HIV and hepatitis C. For example, 42% of new HIV infections are in Black Americans who are 12, 13% of the U.S. population. We see the same disparities with hepatitis C. Mortality or death rates from hepatitis C in Hispanic and non-Hispanic Blacks are twice those in non-Hispanic white people.
This syndemic framework is important because it helps us to look at the context of these diseases, beyond the disease themselves, so the other factors that affect how the disease affects individuals. Those factors can be social, political, environmental, economic, and they contribute to these health inequities. This syndemic approach parallels the Whole Health approach to health, which is a priority of our Health Science Center here in Fort Worth. That Whole Health approach to health considers the whole person. It also recognizes that there are multiple factors influencing individual and community health and that it’s not just the absence of disease, that makes a person healthy.
Alexis: Can you tell us a little bit why you decided to delve into this specific area of research?
Wari: I guess a lot has to do with how I grew up. My dad was a diplomat, and he worked for the United Nations, the High Commission for Refugees specifically. We grew up traveling a lot. I saw a lot, I learned a lot. I know what a refugee camp is like, because my dad took me to one. I know what poverty and no health care looks like, at the very extreme, in really resource-limited settings, because I’ve seen it. And so at perhaps a young age, I became really aware of this difference, this distinction between those who have and those who have not, but I guess importantly, I was always taught that I can, and I should, do something about it.
It’s not particularly surprising to those who know me that I became a physician scientist. I’ve been drawn to this area of research that focuses on public health, health systems prevention, screening, diagnosis and access to care for the underserved and disadvantaged populations, whether that disadvantage is geographic, racial, cultural or economical.
Alexis: One of the things that I noticed in the press release about this app is that some providers may not have the training or maybe not the willingness to take on patients with hepatitis C. Can you explain that a little bit?
Wari: I think one of the things with providers is having a level of comfort in your knowledge and what you know to do what you need to do. I think that that is where there’s a gap.
It’s really important for non-specialist providers to be provided with the tools they need for task-shifting and skill acquisition that gets them to a place of comfort, so they’re confident to manage Hep C. That’s where digital tools like this app can come in to assist with health workforce knowledge acquisition and task-shifting that often happens where human resources are limited.
Another way of assisting health workers and providers with knowledge acquisition is something called telementoring. And telementoring was actually built into the same project that developed the app. In telementoring, they are different models. A model is a webinar. Podcasts are actually a telementoring modality. So is a specific model called ECHO — extension for community healthcare outcomes — that’s a video conferencing telementoring model.
The app additionally directs providers to these additional resources that help them acquire knowledge, but also support them. Once the provider has the knowledge and has the support to do something clinically, they’re more likely to do it.
Alexis: You’ve told us a little bit about the app in your answer there. But can you back up and tell us about the app more globally? What is it and how does it work?
Wari: It’s designed to work in the way an app does — on your phone or tablet. As a practicing physician, it was really important to me that the interface is really intuitive, and that you get to where you need to get to with a few number of taps. And then also that you have all the information that you need within the app, so the app isn’t taking you somewhere externally on the internet, which requires an internet connection. Sometimes you’re in a place where you don’t have a good connection, or you have none at all. All those aspects were taken into consideration with the design with our app developer.
It’s easy to follow to find the sections that you need, and it has some interesting sections. For example, there’s a section about the different ways to access drugs for your patients, HCV drugs, hepatitis C drugs for your patients, because often getting the right drug for a patient is a lot more than just writing the prescription. I’m excited by how easy it is to use and how practical it is to use and it was designed to be that way.
Alexis: Is the app specifically for providers who care for people who have both HIV and hepatitis C? Who is the target audience?
Wari: That’s correct. This app is specifically developed for HIV-HCV co-infections or co-infection with both viruses. (The team and I) use the term ‘providers’ in the broadest possible sense, so it’s anybody involved along the HIV-HCV care continuum. It can be a physician, it can be a nurse practitioner, it can be a physician assistant or pharmacist. But there are a lot of people involved in good care of coinfected patients, including counselors and community health workers. It’s a whole multidisciplinary team.
Alexis: And if a provider is listening to this and wanted to check out the app, how would they go about pursuing it?
Wari: They need a smartphone or a tablet. They would go to either the Google Play Store or the App Store, and they would search and they could find it using keywords — hepatitis, HIV-HCV education — and the app is called the HELP app. That’s the acronym for the app, so that they should be able to find it pretty easily that way. Then they download it, and it should be on their phone or their tablet.
Alexis: And just for free?
Alexis: I know that the app launched yesterday. So that was Monday, May 23. Today is Tuesday, May 24. How is it going so far?
Wari: So far, so good. We have a few launch events this week. The launch event yesterday was a panel discussion about the past, present and future of the HIV and hepatitis C epidemics. That went really well and was well-attended. And we’ve got a couple more events this week. We’ve got a webinar tomorrow, and an ECHO telementoring session on Friday and registrations so far for those are good. It’s a national launch. We’ve utilized our institutional networks, and also national networks like AETC, which stands for AIDS education training centers. That is the training and education arm of the federal Ryan White HIV/AIDS program. We’ve disseminated it across that network and also utilizing social media.
Alexis: How will you measure the success of this app?
Wari: As a scientist, from an evaluation standpoint, we can quantitatively measure the number of downloads. We can, at some point, embed surveys within the app. Success that we perhaps will not be able to measure is exactly how much this app will contribute to the goal of elimination of viral hepatitis by 2030. And it’s elimination not eradication, so it’s eliminating viral hepatitis as a public health problem, reducing new viral hepatitis infections by 90%, and reducing deaths due to viral hepatitis by 65% by 2030, from a baseline of 2015.
I hope that we can contribute to that and we can’t measure how much that contribution will be. I may also not ever have measurable data (from) an individual provider that is wondering, ‘Can I manage Hep C?’ And then looks through the app and at the end of it is like, ‘OK, I can try this,’ and, and then, after using the app, is able to confidently do so. I would call that immeasurable success, but it’s certainly a success.
Alexis: Thank you so much for sharing, Dr. Allison. Is there anything else that you would like to add?
Wari: I really want to acknowledge the bigger team that did this work. I work with a great team, and so I want to acknowledge them. It’s the first app of this kind, (the only) HIV-HCV coinfection app developed fully within the U.S. context.
I also want to acknowledge the funding that we received to develop this resource, which is Ryan White HIV/AIDS Program Special Project of National Significance funding.
I just want to say that I hope that this app significantly contributes to eliminating viral hepatitis as a public health issue in the U.S. by 2030.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.