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Self-Study Modules and Sections

  1. This module is for any clinician who may encounter persons with hepatitis C virus infection and would like to establish core competence in testing for hepatitis C, counseling patients on preventing hepatitis C transmission, and diagnosing acute hepatitis C infection.
  2. This module is intended for clinicians involved in long-term management of persons with chronic hepatitis C infection. Content includes initial evaluation, natural history, preventing liver damage, staging of liver fibrosis, evaluation of cirrhosis, surveillance for hepatocellular carcinoma, and recognition of extrahepatic manifestations.
  3. This module addresses the diagnosis and management of complications that may arise in patients with cirrhosis, including ascites, spontaneous bacterial peritonitis, varicies, hepatic encephalopathy, and referral for liver transplantation. 
  4. This module is for clinicians evaluating patients for hepatitis C treatment, including clinicians who will independently assess treatment candidacy and clinicians who will provide treatment candidacy with assistance from a hepatitis C expert. 
  5. Module 5 is for clinicians treating chronic hepatitis C infection. Material covered includes recommendations for treatment-naive and treatment-experienced HCV-infected patients with genotypes 1-6, based on the AASLD/IDSA HCV Guidance.
  6. This module is designed for clinicians who manage special populations of persons infected with HCV and/or complex HCV-related special treatment issues. Material covered is at an advanced level.
  7. This module is designed for clinicians who would like to review special topics that are not addressed in the existing curriculum. Rapidly changing, or cutting edge topics will be featured in this module. 

Core Competencies for the Hepatitis C Online

It is the goal of Hepatitis C Online to provide ongoing, up-to-date information needed to meet the core competency knowledge for HCV prevention, screening, diagnosis, and ongoing treatment and care to healthcare providers in the United States.

The following is an outline and list of Core Competency Modules (with sub-competency lessons and learning objective performance indicators).

Module 1. Screening and Diagnosis of Hepatitis C Infection

Module Core Competency

Intended Audience and Content Covered: Any clinician who may encounter persons with hepatitis C virus (HCV) infection who would like to establish core competence in screening, testing, and counseling patients regarding their initial testing results. Medical providers intended for this module include Primary Care Physicians, Advanced Registered Nurse Practitioners, Physician Assistants, Hospitalists, Infectious Diseases Specialists, Gastroenterologists, and Hepatologists.

Objectives:
  1. List key features of the hepatitis C epidemic in the United States.
  2. Establish competence in screening and diagnosing of persons with hepatitis C infection.
  3. Summarize the hepatitis C testing sequence for identifying current infection. 
  4. Provide basic counseling for prevention of transmission of hepatitis C infection.
  5. Recognize and diagnose persons with acute hepatitis C infection.
Lessons
Learning Objective Performance Indicators
  1. Describe the epidemiology of hepatitis C in the United States.
  2. Recognize the impact of the hepatitis C epidemic in the United States.
  1. Summarize CDC screening and testing recommendations for chronic hepatitis C infection.
  2. Discuss the impact of the 1945 to 1965 birth cohort hepatitis testing on the hepatitis C epidemic.
  1. Describe screening and supplemental tests used for diagnosing hepatitis C infection. 
  2. Discuss post-test counseling messages and linkage to care for  persons with active hepatitis C virus infection. 
  1. Summarize common routes of hepatitis C transmission.
  2. Discuss appropriate counseling to prevent transmission of hepatitis C virus. 
  1. Recognize the clinical features, if present, in patients with acute hepatitis C infection. 
  2. List appropriate tests to order for the laboratory diagnosis of acute hepatitis C infection.

Module 2. Evaluation, Staging, and Monitoring of Chronic Hepatitis C

Module Core Competency

Intended Audience and Content Covered: Clinicians who play a substantial role in the long-term management of patients with chronic hepatitis C virus (HCV) infection, including Primary Care Physicians, Advanced Registered Nurse Practitioners, Physician Assistants, Infectious Diseases Specialists, Gastroenterologists, and Hepatologists. This module emphasizes the initial evaluation of a patient diagnosed with hepatitis C virus infection, understanding the natural history of hepatitis C, assessment for the degree of liver fibrosis, counseling patients on how to prevent further insults to their liver, evaluation of patients with cirrhosis, surveillance for hepatocellular carcinoma, and recognition of HCV-related extrahepatic manifestations. 

Objectives:
  1. Perform an appropriate initial evaluation of patients with chronic hepatitis C infection.
  2. Summarize the natural history of persons with hepatitis C infection.
  3. Provide appropriate counseling to patients for preventing further liver insults.
  4. Evaluate patients for the extent of hepatitis C-related liver fibrosis.  
  5. Distinguish compensated from decompensated cirrhosis.
  6. Conduct hepatocellular carcinoma surveillance when indicated.
  7. Recognize and diagnose hepatitis C-related extrahepatic manifestations.
Lessons
Learning Objective Performance Indicators
  1. Summarize key aspects of the medical history and physical examination in persons with hepatiits C presenting for  an initial evaluation.  
  2. List key immunizations that should be administered to persons with chronic hepatitis C infection.
  1. Describe the variable outcomes of that can occur in persons with chronic hepatitis C infection.
  2. Discuss factors that influence the rate of progression of fibrosis in persons with chronic hepatitis C infection.
  1. Determine which common liver health counseling messages should be addressed in persons with chronic hepatitis C infection. 
  2. Summarize key counseling messages related to over-the-counter medications, alcohol, marijuana, diet, and complementary medications in persons with chronic hepatitis C infection. 
  1. Explain the indications, risks, and histologic assessment for liver biopsy in persons with chronic hepatitis C infection.
  2. Examine non-invasive tests of liver fibrosis and examine the potential clinical utility of these tests. 
  1. Differentiate compensated cirrhosis from decompensated cirrhosis. 
  2. Summarize classification and prognostic systems for patients with cirrhosis. 
  1. Determine which patients with chronic hepatitis C infection should undergo hepatocellular carcinoma surveillance. 
  2. Describe the American Association for the Study of Liver Diseases (AASLD) recommendations for surveilance for hepatocellular carcinoma.
  1. Recognize the clinical syndromes associated with hepatitis C-related cryoglobulinemia.
  2. Describe the renal and dermatologic extrahepatic manifestations associated with chronic hepatitis C infection.

Module 3. Management of Cirrhosis-Related Complications

Module Core Competency

Intended Audience and Content Covered: This module is intended for clinicians who provide long-term management of persons with hepatitis C virus (HCV) infection.  Medical providers intended for this module include Primary care physicians, Advanced Registered Nurse Practitioners, Physician Assistants, Hospitalists, Infectious Diseases Specials, Gastroenterologists, and Hepatologists. The content covered includes the recognition of cirrhosis-related complications, including the recognition, basic management, and prevention of ascites, spontaneous bacterial peritonitis, varices, and encephalopathy.  This module also addresses when to refer a patient to a hepatologist and when to refer for liver transplantation evaluation.

Objectives:
(1) Recognize and manage ascites in patients with cirrhosis.
(2) Demonstrate an understanding of the manifestations and treatment of spontaneous bacterial peritonitis.
(3) Provide screening for varices in patients with cirrhosis and when indicated variceal bleeding prophylaxis. 
(4) Establish competency to Identify and manage hepatic encephalopathy.
(5) Appropriately refer patients for liver transplantation evaluation when indicated.

Lessons
Learning Objective Performance Indicators
  1. Establish an understanding of appropriate technique for performing abdominal paracentesis.
  2. Summarize appropriate medical management and dietary recommendations for patients with ascites. 
  1. Differentiate spontaneous bacterial peritonitis from secondary bacterial peritonitis.
  2. Select and utilize appropriate antimicrobial therapy for patients with spontaneous bacterial peritonitis.
  1. Indentify which patients with cirrrhosis should receive primary prophylaxis against variceal bleeding. 
  2. Use nonselective beta-blockers as prophylaxis against variceal bleeding when prophylaxis is indicated.
  1. Summarize the clinical features of patients with hepatic encephalopathy and describe specific diagnostic tests.
  2. Utilize appropriate medical therapy for patients with hepatitic encephalopathy.
  1. Summarize the major indications and important timing events for liver transplantation evaluation referral.
  2. Determine a MELD score for all patients with cirrhosis and reflect on whether the score indicates a need for liver transplantaion referral.

Module 4. Evaluation and Preparation for Hepatitis C Treatment

Module Core Competency

Intended Audience: Clinicians evaluating patients for possible hepatitis C treatment, including (1) clinicians who independently assess treatment candidacy and (2) clinicians who perform treatment candidacy evaluation with assistance from a hepatitis C expert. This module is intended for medical providers who have a special interest and focus in the treatment of hepatitis C, including Primary Care Physicians, Advanced Registered Nurse Practitioners, and Physician Assistants.  In addition, this module is appropriate for physicians with advanced training in Infectious Diseases, Gastroenterology, or Hepatology.

Objectives:
  1. Establish competence in evaluating patients for hepatitis C treatment candidacy,
  2. Determine treatment goals and discuss predictors of treatment response, and
  3. Identify treatment barriers and address these barriers prior to treatment.
Lessons
Learning Objective Performance Indicators
  1. Discuss the goals and rationale for hepatitis C therapy with patients considering treatment. 
  2. Predict a patient's response to treatment for chronic hepatitis C infection based on specific host and viral factors.
  1. Reflect on the indications, contraindications, and patient readiness when considering initiating hepatitis C therapy.
  2. Integrate knowledge of new medications when considering the timing of initiating hepatitis C therapy.
  1. Summarize the costs of direct acting antiviral agents used to treat hepatitis C.
  2. Describe major steps in accessing new direct-acting antiviral medications used to treat hepatitis C.
  1. Summarize the impact of substance or alcohol use on hepatitis C treatment decisions in the modern era of treatment with direct-acting antiviral agents.
  2. Integrate support services and management strategies into programs for patients with substance or alcohol use who have chronic hepatitis C infection.
  1. List different methods to measure patient adherence when receiving hepatitis C therapy. 
  2. Identify barriers to adherence and discuss strategies than can maximize aherence. 

Module 5. Treatment of Chronic Hepatitis C Infection

Module Core Competency
Intended Audience: This module is intended for clinicians who treat hepatitis C virus infection, including clinicians treating with assistance or co-management with an expert and those independently treating hepatitis C infection.  This module will include review of all FDA-approved agents used to treat hepatitis C, including newer FDA-approved direct acting agents.  The content will address the virologic responses to therapy, recommended therapy for treatment-naïve and treatment experienced patients, and monitoring and management of treatment-related adverse effects. Medical providers intended for this module include Primary Care Physicians, Advanced Registered Nurse Practitioners, and Physician Assistants who have a special interest and focus in the treatment of hepatitis C, and physicians with advanced training in Infectious Diseases, Gastroenterology, or Hepatology.

Objectives:
  1. Summarize recommended treatments for chronic hepatitis C genotypes 1-6.
  2. Understand prferred and alternative treatment options for patients with chronic hepatitis C, and 
  3. Discuss different approaches for treatment-naïve and treatment-experienced patients with chronic hepatitis C.  
Lessons
Learning Objective Performance Indicators
  1. Discuss preferred therapies for initial treatment of patients with genotype 1a or 1b chronic HCV.
  2. List the preferred therapy for retreatment of patients with HCV genotype 1a or 1b chronic infection who have previously failed therapy.
  1. List preferred therapies for initial treatment of patients with genotype 2 chronic HCV.
  2. Describe the preferred therapy for retreatment of patients with HCV genotype 2 chronic infection who have failed prior therapy.
  1. List preferred therapies for initial treatment of patients with genotype 3 chronic HCV.
  2. Describe the preferred therapy for retreatment of patients with HCV genotype 3 chronic infection who have failed prior therapy.
  1. Understand the preferred therapies for the intial treatment of patients with genotype 4 chronic HCV.
  2. State the preferred therapy for retreatment of patients with HCV genotype 4 chronic infection in whom prior therapy has failed.
  1. List the preferred therapies for the initial treatment of patients with genotype 5 or 6 chronic HCV.
  2. Discuss the preferred approach to retreatment of patients with HCV genotype 5 or 6 chronic infection who have failed prior therapy.
  1. List the recommended monitoring for treatment efficacy and safety in patients receiving hepatitis C therapy.
  2. Summarize appropriate monitoring for patients after treatment for hepatitis C.

Module 6. Treatment of Special Populations and Special Situations

Module Core Competency

Intended Audience: This module is designed for clinicians who manage special populations of persons infected with HCV who have complex HCV-related treatment issues. This module addresses advanced level topics and is intended for physicians with advanced training in Infectious Diseases, Gastroenterology, or Hepatology. In addition, this module is appropriate for Primary Care Physicians, Advanced Registered Nurse Practitioners, and Physician Assistants who have a special interest and advanced-level hepatitis C clinical practice. 

Objectives:
  1. Discuss unique aspects of managing hepatitis C in special populations,
  2. Recognize patient groups at high risk for treatment-related complications, and
  3. Establish competence in advanced treatment issues. 
Lessons
Learning Objective Performance Indicators
  1. Explain the concept of spontaneous HCV clearance after acute infection and how this impacts treatment stragies. 
  2. Formulate an approach to evaluation and treatment of persons with acute hepatitis C infection.
  1. Discuss key studies using direct-acting antiviral agents to treat hepatitis C in persons coinfected with HIV.
  2. Develop an understanding of recommended approach to treating hepatitis C in persons with HIV coinfection.
  1. Explain the interaction of hepatitis C and renal disease.
  2. Discuss hepatitis C treatment approaches in patients with chronic renal insufficiency.
  1. Provide appropriate hepatitis C treatment options for patients with compensated cirrhosis. 
  2. Discuss approaches to treatment of hepatitis C in patients with decompensated cirrhosis.
  1. Appreciate the devastating impact of reinfection with hepatitis C in post-liver transplantation patients.
  2. Summarize interferon-free treatment options for patients with hepatitis C reinfection in the post-liver transplantation setting.
  1. Summarize the prevalence data and importance of addressing hepatitis C in the correctional setting.
  2. Discuss challenges of treating hepatitis C in corrections.

Module 7. Special Topics

Module Core Competency

Intended Audience: This module is designed for clinicians who would like review topics or subjects not addressed in the existing curriculum. Topics will feature new or state-of-the-art topics related to treatment of hepatitis C.

Objectives
1. Increase awareness of future therapies available for the treatment of hepatitis C.
2. Summarize major drugs in development for the treatment of hepatitis C.
3. Discuss key concepts of HCV protease inhibitor resistance. 

Lessons
Learning Objective Performance Indicators
  1. Discuss the treatment indications and appropriate treatment duration when using Ledipasvir-sofosbuvir (Harvoni) for chronic hepatitis C infection. 
  2. Summarize key findings from the ION-1, ION-2, and ION-3 trials.
  1. Understand HCV resistance concepts.
  2. Summarize the impact of baseline NS3 and NS5A resistance. 
  3. Describe treatment approaches to patients with HCV resistance to DAAs. 

Progress Tracker

Module 1
This module is for any clinician who may encounter persons with hepatitis C virus infection and would like to establish core competence in testing for hepatitis C, counseling patients on preventing hepatitis C transmission, and diagnosing acute hepatitis C infection.
Module 2
This module is intended for clinicians involved in long-term management of persons with chronic hepatitis C infection. Content includes initial evaluation, natural history, preventing liver damage, staging of liver fibrosis, evaluation of cirrhosis, surveillance for hepatocellular carcinoma, and recognition of extrahepatic manifestations.
Module 3
This module addresses the diagnosis and management of complications that may arise in patients with cirrhosis, including ascites, spontaneous bacterial peritonitis, varicies, hepatic encephalopathy, and referral for liver transplantation. 
Module 4
This module is for clinicians evaluating patients for hepatitis C treatment, including clinicians who will independently assess treatment candidacy and clinicians who will provide treatment candidacy with assistance from a hepatitis C expert. 
Module 5
Module 5 is for clinicians treating chronic hepatitis C infection. Material covered includes recommendations for treatment-naive and treatment-experienced HCV-infected patients with genotypes 1-6, based on the AASLD/IDSA HCV Guidance.
Module 6
This module is designed for clinicians who manage special populations of persons infected with HCV and/or complex HCV-related special treatment issues. Material covered is at an advanced level.
Module 7
This module is designed for clinicians who would like to review special topics that are not addressed in the existing curriculum. Rapidly changing, or cutting edge topics will be featured in this module. 
Lesson 1 
Objectives:

  1. Describe the epidemiology of hepatitis C in the United States.
  2. Recognize the impact of the hepatitis C epidemic in the United States.

 
Objectives:

  1. Summarize key aspects of the medical history and physical examination in persons with hepatiits C presenting for  an initial evaluation.  
  2. List key immunizations that should be administered to persons with chronic hepatitis C infection.

 
Objectives:

  1. Establish an understanding of appropriate technique for performing abdominal paracentesis.
  2. Summarize appropriate medical management and dietary recommendations for patients with ascites. 

 
Objectives:

  1. Discuss the goals and rationale for hepatitis C therapy with patients considering treatment. 
  2. Predict a patient's response to treatment for chronic hepatitis C infection based on specific host and viral factors.

 
Objectives:

  1. Discuss preferred therapies for initial treatment of patients with genotype 1a or 1b chronic HCV.
  2. List the preferred therapy for retreatment of patients with HCV genotype 1a or 1b chronic infection who have previously failed therapy.

 
Objectives:

  1. Explain the concept of spontaneous HCV clearance after acute infection and how this impacts treatment stragies. 
  2. Formulate an approach to evaluation and treatment of persons with acute hepatitis C infection.

 
Objectives:

  1. Discuss the treatment indications and appropriate treatment duration when using Ledipasvir-sofosbuvir (Harvoni) for chronic hepatitis C infection. 
  2. Summarize key findings from the ION-1, ION-2, and ION-3 trials.

Lesson 2 
Objectives:

  1. Summarize CDC screening and testing recommendations for chronic hepatitis C infection.
  2. Discuss the impact of the 1945 to 1965 birth cohort hepatitis testing on the hepatitis C epidemic.

 
Objectives:

  1. Describe the variable outcomes of that can occur in persons with chronic hepatitis C infection.
  2. Discuss factors that influence the rate of progression of fibrosis in persons with chronic hepatitis C infection.

 
Objectives:

  1. Differentiate spontaneous bacterial peritonitis from secondary bacterial peritonitis.
  2. Select and utilize appropriate antimicrobial therapy for patients with spontaneous bacterial peritonitis.

 
Objectives:

  1. Reflect on the indications, contraindications, and patient readiness when considering initiating hepatitis C therapy.
  2. Integrate knowledge of new medications when considering the timing of initiating hepatitis C therapy.

 
Objectives:

  1. List preferred therapies for initial treatment of patients with genotype 2 chronic HCV.
  2. Describe the preferred therapy for retreatment of patients with HCV genotype 2 chronic infection who have failed prior therapy.

 
Objectives:

  1. Discuss key studies using direct-acting antiviral agents to treat hepatitis C in persons coinfected with HIV.
  2. Develop an understanding of recommended approach to treating hepatitis C in persons with HIV coinfection.

 
Objectives:

  1. Understand HCV resistance concepts.
  2. Summarize the impact of baseline NS3 and NS5A resistance. 
  3. Describe treatment approaches to patients with HCV resistance to DAAs. 

Lesson 3 
Objectives:

  1. Describe screening and supplemental tests used for diagnosing hepatitis C infection. 
  2. Discuss post-test counseling messages and linkage to care for  persons with active hepatitis C virus infection. 

 
Objectives:

  1. Determine which common liver health counseling messages should be addressed in persons with chronic hepatitis C infection. 
  2. Summarize key counseling messages related to over-the-counter medications, alcohol, marijuana, diet, and complementary medications in persons with chronic hepatitis C infection. 

 
Objectives:

  1. Indentify which patients with cirrrhosis should receive primary prophylaxis against variceal bleeding. 
  2. Use nonselective beta-blockers as prophylaxis against variceal bleeding when prophylaxis is indicated.

 
Objectives:

  1. Summarize the costs of direct acting antiviral agents used to treat hepatitis C.
  2. Describe major steps in accessing new direct-acting antiviral medications used to treat hepatitis C.

 
Objectives:

  1. List preferred therapies for initial treatment of patients with genotype 3 chronic HCV.
  2. Describe the preferred therapy for retreatment of patients with HCV genotype 3 chronic infection who have failed prior therapy.

 
Objectives:

  1. Explain the interaction of hepatitis C and renal disease.
  2. Discuss hepatitis C treatment approaches in patients with chronic renal insufficiency.

Lesson 4 
Objectives:

  1. Summarize common routes of hepatitis C transmission.
  2. Discuss appropriate counseling to prevent transmission of hepatitis C virus. 

 
Objectives:

  1. Explain the indications, risks, and histologic assessment for liver biopsy in persons with chronic hepatitis C infection.
  2. Examine non-invasive tests of liver fibrosis and examine the potential clinical utility of these tests. 

 
Objectives:

  1. Summarize the clinical features of patients with hepatic encephalopathy and describe specific diagnostic tests.
  2. Utilize appropriate medical therapy for patients with hepatitic encephalopathy.

 
Objectives:

  1. Summarize the impact of substance or alcohol use on hepatitis C treatment decisions in the modern era of treatment with direct-acting antiviral agents.
  2. Integrate support services and management strategies into programs for patients with substance or alcohol use who have chronic hepatitis C infection.

 
Objectives:

  1. Understand the preferred therapies for the intial treatment of patients with genotype 4 chronic HCV.
  2. State the preferred therapy for retreatment of patients with HCV genotype 4 chronic infection in whom prior therapy has failed.

 
Objectives:

  1. Provide appropriate hepatitis C treatment options for patients with compensated cirrhosis. 
  2. Discuss approaches to treatment of hepatitis C in patients with decompensated cirrhosis.

Lesson 5 
Objectives:

  1. Recognize the clinical features, if present, in patients with acute hepatitis C infection. 
  2. List appropriate tests to order for the laboratory diagnosis of acute hepatitis C infection.

 
Objectives:

  1. Differentiate compensated cirrhosis from decompensated cirrhosis. 
  2. Summarize classification and prognostic systems for patients with cirrhosis. 

 
Objectives:

  1. Summarize the major indications and important timing events for liver transplantation evaluation referral.
  2. Determine a MELD score for all patients with cirrhosis and reflect on whether the score indicates a need for liver transplantaion referral.

 
Objectives:

  1. List different methods to measure patient adherence when receiving hepatitis C therapy. 
  2. Identify barriers to adherence and discuss strategies than can maximize aherence. 

 
Objectives:

  1. List the preferred therapies for the initial treatment of patients with genotype 5 or 6 chronic HCV.
  2. Discuss the preferred approach to retreatment of patients with HCV genotype 5 or 6 chronic infection who have failed prior therapy.

 
Objectives:

  1. Appreciate the devastating impact of reinfection with hepatitis C in post-liver transplantation patients.
  2. Summarize interferon-free treatment options for patients with hepatitis C reinfection in the post-liver transplantation setting.

Lesson 6 
Objectives:

  1. Determine which patients with chronic hepatitis C infection should undergo hepatocellular carcinoma surveillance. 
  2. Describe the American Association for the Study of Liver Diseases (AASLD) recommendations for surveilance for hepatocellular carcinoma.

 
Objectives:

  1. List the recommended monitoring for treatment efficacy and safety in patients receiving hepatitis C therapy.
  2. Summarize appropriate monitoring for patients after treatment for hepatitis C.

 
Objectives:

  1. Summarize the prevalence data and importance of addressing hepatitis C in the correctional setting.
  2. Discuss challenges of treating hepatitis C in corrections.

Lesson 7 
Self-Assessment 
 
 
 
 
 

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