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Self-Study Modules and Sections
- Explore in depth epidemiology related to hepatitis C virus (HCV) and then learn how to screen and diagnose chronic and acute HCV, as well as counsel on how to prevent HCV transmission.
- Delve into how to manage persons with chronic hepatitis C. Seven lessons address initial evaluation, natural history, liver damage prevention, evaluation for cirrhosis, and surveillance for hepatocellular carcinoma.
- Explore how to diagnosis and manage complications that may arise with chronic hepatitis C infection, including ascites, bacterial peritonitis, varicies, and hepatic encephalopathy. Also learn about referral for liver transplantation evaluation.
- Learn about goals of HCV treatment, what to consider prior to initiating hepatitis C treatment in persons with chronic HCV infection, and how to address barriers that may interfere with persons receiving hepatitis C treatment.
- Learn about simplified HCV treatment for all HCV genotypes and how to treat persons with prior HCV treatment experience, cirrhosis, or acute HCV infection.
- Examine how to treat HCV in persons with HIV coinfection, renal impairment, and substance use. Develop an understanding of how to manage exposure to HCV in the workplace and learn about perinatal HCV transmission.
- In this hepatitis C fundamentals 5-hour, highly interactive module, health care providers will develop core proficiency in screening and diagnosing hepatitis C, providing simplified treatment of hepatitis C with direct acting antivirals (DAAs), and assessing for cure. Learners who complete all five lessons in this module may take an optional 20-que
Core Competencies for the Hepatitis C Online
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
Apply Evidence-Based Recommendations to Provide Screening and Diagnosis of HCV Infection
Lessons
Learning Objective Performance Indicators
- Describe the epidemiologic profile of the HCV epidemic in the United States
- Discuss application of HCV epidemiological data in public health planning
- Identify key risk factors and their mitigation for transmission of HCV
- Describe the impact of the ongoing opioid epidemic on trends in HCV epidemiology
- Summarize Centers for Disease Control and Prevention (CDC) case definitions for acute and chronic HCV infection
- Discuss 2020 Centers for Disease Control (CDC) recommendations for HCV screening
- List the 2020 US Preventive Services Task Force (USPSTF) screening recommendations for HCV infection
- Explain the rationale for universal HCV screening in the United States
- List the CDC recommendations for HCV screening in perinatally exposed infants and children
- Summarize the rationale for routine HCV screening in perinatally exposed infants and children
- Describe screening and supplemental tests used for diagnosing HCV infection
- Summarize the recommended HCV testing sequence involving antibody and RNA testing
- Discuss post-test counseling messages and linkage to care for persons with active HCV infection
- Interpret HCV test results correctly
- Communicate meaning of HCV test results to persons who undergo testing
- List common routes of HCV transmission
- Discuss appropriate counseling to prevent sexual transmission of HCV
- Describe counseling messages to prevent transmission of HCV through injection drug use
- Explain prevention messages for preventing household transmission of HCV
- Summarize counseling messages for preventing perinatal HCV transmission
- Define acute HCV infection
- Recognize the clinical features, if present, in persons with acute HCV infection
- Describe the timing of positivity with HCV RNA and HCV antibody tests after acquisition of HCV
- List appropriate laboratory tests required to make a diagnosis of acute HCV infection
- Summarize the approach for laboratory testing following a known exposure to HCV
Module 2. Evaluation, Staging, and Monitoring of Chronic Hepatitis C
Module Core Competency
Provide Evidence-Based Evaluation, Staging, and Monitoring to Persons with Chronic Hepatitis C Infection
Lessons
Learning Objective Performance Indicators
- Describe key aspects of the medical history to obtain in a new evaluation of persons with HCV infection
- Identify key abnormal physical examination findings that may be present in a person with HCV and cirrhosis
- Summarize recommended laboratory studies to obtain for a person with HCV at the initial evaluation visit
- List immunizations that should be administered to persons with chronic HCV infection
- Discuss the evaluation of secondary causes of liver disease in persons with chronic HCV infection
- Explain spontaneous viral clearance versus persistent infection following initial HCV acquisition
- Describe the variable outcomes that can occur in persons with chronic HCV infection
- Summarize the typical time course for developing liver complications in untreated chronic HCV
- List factors that influence the rate of progression of fibrosis in persons with chronic HCV infection
- Discuss the impact of alcohol intake on fibrosis progression in persons with chronic HCV infection
- Determine which common liver health counseling messages should be addressed in persons with chronic HCV infection
- Explain recommendations for intake of acetaminophen and nonsteroidal anti-inflammatory medications in persons with chronic HCV infection
- Discuss recommendations for iron intake and vitamins for persons with chronic HCV infection
- Summarize key counseling messages related to coffee, diet, and complementary medications in persons with chronic HCV infection
- Clarify guidance related to alcohol and marijuana use in persons with chronic HCV infection
- Discuss noninvasive indirect markers used for estimating liver fibrosis
- Describe noninvasive direct markers used for estimating liver fibrosis
- Summarize key radiologic methods that can estimate hepatic fibrosis
- List the transient elastography cutoff that is used to estimate cirrhosis in persons with chronic HCV
- Explain the indications, risks, and histologic assessment for liver biopsy in persons with chronic HCV
- Differentiate compensated cirrhosis from decompensated cirrhosis
- Explain the classification and prognostic systems for cirrhosis
- Summarize important aspects of the medical history and physical examination in persons with cirrhosis
- Discuss the approach to treatment of HCV in persons with compensated cirrhosis
- Describe key manifestations and complications associated with decompensated cirrhosis
- Discuss the incidence of hepatocellular carcinoma (HCC) in persons with chronic HCV
- Describe major risk factors for developing HCC
- Explain the rationale for HCC surveillance in persons with chronic HCV infection
- Summarize the American Association for the Study of Liver Diseases (AASLD) recommendations for HCC surveillance indications
- List recommended HCC surveillance methods
- Identify the most common clinical syndromes associated with HCV-related cryoglobulinemia
- Describe the renal extrahepatic manifestations associated with chronic HCV infection
- Recognize the most common dermatologic extrahepatic manifestations associated with chronic HCV infection
- Explain the relationship of chronic HCV infection and lymphomas
- Summarize the association of chronic HCV and cardiovascular disease
Module 3. Management of Cirrhosis-Related Complications
Module Core Competency
Apply Evidence-Based Recommendations to Management of Cirrhosis-Related Complications in Persons with HCV Infection
Lessons
Learning Objective Performance Indicators
- Provide a list of causes in the differential diagnosis of ascites
- Diagnose ascites based on physical examination findings
- Describe the appropriate technique for performing abdominal paracentesis
- Summarize appropriate medical management and dietary recommendations for persons with ascites
- Discuss ascites-associated complications and treatment
- Explain the diagnostic criteria for spontaneous bacterial peritonitis
- Differentiate spontaneous bacterial peritonitis from secondary bacterial peritonitis
- Select appropriate antimicrobial therapy for persons with spontaneous bacterial peritonitis
- List indications for initiating primary and secondary bacterial peritonitis prophylaxis
- Discuss appropriate regimens for primary and secondary bacterial peritonitis prophylaxis
- Explain the basic pathogenesis of cirrhosis-related portal hypertension
- Describe how to diagnose clinically-significant portal hypertension
- Discuss the rationale and indications for variceal screening in persons with cirrhosis
- Summarize recommendations for prophylaxis of variceal bleeding
- List key aspects of managing acute variceal bleeding
- List the clinical features of persons with hepatic encephalopathy
- Describe specific diagnostic tests used to diagnose hepatic encephalopathy
- Summarize the approach to management of persons with hepatic encephalopathy
- Explain the rationale for using nonabsorbable disaccharides for the treatment of hepatic encephalopathy
- Discuss the role of antimicrobial therapy for the treatment of hepatic encephalopathy
- List the most common indications for cirrhosis-related liver transplantation
- Discuss the timing of referral for liver transplantation in the United States
- Use and interpret the Model for End-Stage Liver Disease (MELD) prognostic scoring system
- Describe the relative contraindications for liver transplantation
- Summarize the absolute contraindications for liver transplantation
Module 4. Evaluation and Preparation for Hepatitis C Treatment
Module Core Competency
Provide Evidence-Based Evaluation and Preparation for Treatment of Persons with Hepatitis C Infection
Lessons
Learning Objective Performance Indicators
- Cite the goals and rationale for HCV therapy in persons with chronic HCV
- Discuss durability of sustained virologic response when achieved with direct-acting antiviral therapy
- List several long-term benefits of HCV treatment on clinical outcomes in persons with chronic HCV
- Describe the impact of HCV treatment on survival
- Summarize the population-level benefit of HCV treatment
- Summarize current recommendations for HCV treatment indications in persons with chronic HCV
- List absolute contraindications for HCV treatment with direct-acting antiviral therapy
- Discuss relative contraindications for HCV treatment with direct-acting antiviral therapy
- Describe key patient readiness factors to assess prior to initiating treatment
- Outline general monitoring recommendations when HCV treatment is deferred
- State the key steps in HCV care continuum
- List major barriers to hepatitis C testing
- Describe approaches for improving linkage to hepatitis C care services
- Explain potential insurance and Medicaid restrictions that can limit access to HCV treatment
- Discuss strategies for expanding hepatitis C medical provider capacity
Module 5. Treatment of Hepatitis C Infection
Module Core Competency
Apply Evidence-Based Treatment for Hepatitis C Infection
Lessons
Learning Objective Performance Indicators
- Summarize the eligibility criteria for the American Association for the Study of Liver Disease/Infectious Diseases Society of America (AASLD/IDSA) simplified HCV treatment algorithm
- Discuss how to assess liver fibrosis, including identifying decompensated cirrhosis
- List the direct-acting antiviral (DAA) treatment regimens recommended as part of the AASLD/IDSA simplified guidance
- Describe on-treatment monitoring for adults during HCV treatment using the simplified AASLD/IDSA guidance
- Describe appropriate post-treatment monitoring for adults after completing HCV treatment
- Discuss the approach to retreatment of patients with chronic hepatitis C in the direct-acting antiviral (DAA) era
- List the preferred therapeutic combinations for retreatment in persons with prior sofosbuvir-containing regimens
- Describe recommended options for retreatment in persons with prior treatment with elbasvir-grazoprevir
- Review preferred retreatment options for persons with prior treatment with glecaprevir-pibrentasvir
- Summarize options for persons with multiple prior DAA treatment failures
- List the recommended monitoring for treatment efficacy and safety in adults receiving HCV therapy
- Discuss monitoring for hepatitis B virus reactivation during HCV therapy
- Summarize the approach to persons with elevated alanine aminotransferase levels (ALT) during therapy
- Define sustained virologic response
- Describe appropriate monitoring for patients after HCV treatment
- Distinguish persons with compensated cirrhosis from those with decompensated cirrhosis
- Summarize the impact of treating HCV in persons with cirrhosis
- Discuss major studies involving regimens with pangenotypic activity used to treat HCV in persons with compensated cirrhosis
- Provide appropriate HCV treatment options for persons with compensated cirrhosis
- List approaches to treatment of HCV in persons with decompensated cirrhosis
- Discuss HCV epidemiologic features of acute hepatitis C virus (HCV) infection in the United States
- Explain spontaneous HCV clearance after acute infection and its impact on treatment strategies
- Formulate an approach to evaluate and treat persons with acute HCV infection
- Describe timing for initiating treatment of persons with acute HCV infection
- Summarize recommendations for treatment regimens for persons with acute HCV infection
Module 6. Treatment of Key Populations and Unique Situations
Module Core Competency
Apply Evidence-Based HCV Treatment to Key Populations and in Unique Situations
Lessons
Learning Objective Performance Indicators
- Explain the impact of HIV on the progression of liver fibrosis in persons with untreated chronic HCV
- Describe current HCV treatment approaches in persons with HIV coinfection
- Discuss HCV treatment responses in persons with HIV and HCV coinfection compared with responses in persons with HCV monoinfection
- Summarize recommendations for treating HIV in persons with HCV and HIV coinfection
- List key drug interactions between HCV direct-acting antivirals and HIV antiretroviral medications
- Explain the impact of HCV on renal disease
- Summarize the main findings from HCV treatment studies in people with renal disease
- Discuss dosing of direct-acting antiviral medications in persons with chronic renal disease
- Describe appropriate HCV treatment in persons prior to renal transplantaton
- Summarize HCV treatment recommendations in persons following renal transplantation
- Discuss the prevalence of substance use among persons in the United States
- Describe HCV treatment responses in persons with substance use disorders compared with those who do not have substance use disorders
- Summarize HCV treatment eligibility in persons who have a past or current substance use disorder
- List support services and management strategies for persons with substance use disorders who have chronic HCV infection
- Explain the concept of HCV reinfection in persons who inject drugs
- Describe HCV prevalence in the correctional setting
- Explain the difference between jails and prisons
- Summarize HCV screening recommendations in correctional settings
- State recommendations for HCV treatment eligibility in prisons
- Discuss HCV treatment approach in prisons
- List the definition of health care personnel
- Estimate the risk of HCV seroconversion after an occupational exposure to HCV that involves a needlestick injury
- Describe management of health care personnel exposed to HCV, based on type and nature of exposure
- Summarize monitoring and follow-up testing of health care personnel after occupational exposure to HCV
- Discuss the treatment approach for health care personnel who acquire HCV from an occupational exposure
- Describe the current guidelines for HCV screening in pregnant women
- Identify the risk of mother-to-child transmission of HCV and factors associated with increased risk of transmission
- Summarize the impact of HCV on pregnancy outcomes
- Describe interventions and/or prophylactic measures to reduce the risk of mother-to-child transmission of HCV
- List recommendations for HCV testing and management in infants born to mothers with HCV.
Module 8. HCV Test and Cure
Module Core Competency
Lessons
Learning Objective Performance Indicators
- Increase treatment rates in the United States for adults with hepatitis C virus (HCV) infection
- Describe key epidemiologic features of HCV infection in the United States
- Utilize knowledge about HCV acquisition to prevent new HCV infections
- Recognize the progression of liver disease in untreated HCV infection
- Adopt the simplified HCV treatment approach to expand treatment of HCV by primary care clinicians
- Perform universal HCV screening in persons in the United States
- Recognize HCV acquisition factors to inform periodic, repeat HCV testing
- Effectively implement HCV testing sequence recommendations from the Centers for Disease Control and Prevention
- Correctly interpret HCV antibody and HCV RNA test results to determine HCV status
- Counsel persons with HCV on how to prevent HCV transmission
- Initiate a comprehensive clinical and laboratory evaluation prior to treating a person for HCV infection
- Obtain the recommended core set of laboratory tests indicated for persons prior to starting HCV treatment
- Differentiate laboratory testing recommendations in persons with HCV based on cirrhosis status
- Correctly interpret test results for noninvasive assessment tools used to stage liver fibrosis
- Recognize the conditions that would lead to a presumptive diagnosis of decompensated cirrhosis
- Provide a rationale for treating all people with HCV except persons with less than a 12-month life expectancy
- Adhere to inclusion and exclusion criteria for who is eligible to receive simplified HCV treatment
- Choose an appropriate recommended regimen for simplified HCV treatment
- Conduct laboratory monitoring for persons receiving simplified HCV treatment, including assessment for sustained virologic response
- Manage incomplete treatment adherence based on time into treatment and number of days of missed doses
- Perform follow-up monitoring of persons after treatment for chronic HCV
- Obtain an HCV RNA assay as appropriate to screen for HCV reinfection after a person clears HCV
- Administer priority immunizations for people with chronic HCV
- Engage a person with chronic or cleared HCV in a discussion about measures that promote liver health
- Institute routine screening for hepatocellular carcinoma and varices for persons with cirrhosis
Curriculum Progress Tracker - 4th Edition
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3rd Edition. There is a newer edition of this curriculum.
Curriculum Progress Tracker - 3rd Edition
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