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Treating the Hardest to Treat: Reframing the Hospital Admission as an Opportunity to Initiate Hepatitis C Treatment

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Abstract

Background

Chronic hepatitis C (CHC) is traditionally treated in the outpatient setting. Despite the excellent tolerability, shortened treatment duration, and high cure rates of newer direct-acting antivirals (DAAs), many vulnerable patients remain untreated due to issues with linkage to care.

Aims

This study sought to reframe and establish the hospital admission as a unique opportunity to initiate antiviral treatment for patients with CHC, particularly those with psychosocial or linkage to care issues.

Methods

Patients with untreated CHC were identified either on the Psychiatry or Med/Surg wards at the Veterans Affairs Palo Alto Health Care System (VAPAHCS). If found to be appropriate for treatment initiation, patients were started on antivirals during their hospitalization and followed closely while inpatient and after discharge to assess for sustained virologic response (SVR), treatment tolerability, and treatment completion.

Results

Overall, 36% (23) of potential treatment candidates were initiated on DAA treatment during their hospitalization. Of these patients, 91.3% had documented treatment completion with an intention-to-treat and modified intention-to-treat SVR rate of 91.3% and 100%, respectively.

Conclusions

We establish the hospital admission as a valuable opportunity for HCV treatment initiation, yielding excellent treatment outcomes in those who would not otherwise be treated and achieved a modified intention-to-treat response rate of 100%.

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Author information

Authors and Affiliations

  1. Department of Medicine, VA Palo Alto Health Care System, 3801 Miranda Ave (111), Palo Alto, CA, 94304, USA

    Elizabeth Le & Miki Kwan

  2. Pharmacy Service, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA

    Grace Chee

  3. Division of Gastroenterology and Hepatology, Department of Medicine, VA Palo Alto Health Care System (111), 3801 Miranda Ave, Palo Alto, CA, 94304, USA

    Ramsey Cheung

  4. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, 94305, USA

    Ramsey Cheung

Authors
  1. Elizabeth Le
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  4. Ramsey Cheung
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Contributions

Each named author has substantially contributed to conducting the underlying research and drafting this manuscript.

Corresponding author

Correspondence to Elizabeth Le.

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Conflict of interest

Elizabeth Le, Grace Chee, Miki Kwan: none. Ramsey Cheung: Research support from Gilead Sciences.

Ethical approval

As a quality improvement project to improve access to care, this project was evaluated in the Stanford IRB determination process and found to be IRB exempt. All veterans, or their surrogate decision makers, started on HCV treatment provided verbal consent to treatment with DAA medications.

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Le, E., Chee, G., Kwan, M. et al. Treating the Hardest to Treat: Reframing the Hospital Admission as an Opportunity to Initiate Hepatitis C Treatment. Dig Dis Sci 67, 1244–1251 (2022). https://doi.org/10.1007/s10620-021-06941-3

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  • DOI: https://doi.org/10.1007/s10620-021-06941-3

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