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Inpatient Hepatitis C Treatment Coordination and Initiation for Patients Who Inject Drugs

  • Innovations in Clinical Practice
  • Published:
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Abstract

Background

With hepatitis C (HCV) incidence rising due to injection drug use, people who inject drugs (PWID) are a priority population for direct-acting antivirals (DAA). However, significant barriers exist. At our institution, hospitalized PWID were screened for HCV but not effectively linked to care.

Aim

To improve retention in HCV care among hospitalized PWID.

Setting

Quaternary academic center in the Southeast US from August 2021 through August 2022.

Participants

Hospitalized PWID with HCV.

Program Description

E-consultation-prompted care coordination and HCV treatment with outpatient telehealth.

Program Evaluation

Care cascades were constructed to assess retention and HCV treatment, with the primary outcome defined as DAA completion or sustained virologic response after week 4. Of 28 patients, 11 started DAAs inpatient, 8 initiated outpatient, and 9 were lost to follow-up or transferred care. Overall, 82% were linked to care and 52% completed treatment. For inpatient initiators, 73% achieved the outcome. Of non-inpatient initiators, 71% were linked to care, 53% started treatment, and 36% achieved the outcome.

Discussion

Inpatient HCV treatment coordination, including DAA initiation, and telehealth follow-up, was feasible and highly effective for hospitalized PWID. Future steps should address barriers to inpatient DAA treatment and expand this model to other similar patient populations.

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Data Availability

The datasets generated and analyzed during the current study are not publicly available as the data was derived from clinical records as part of a QI program, not explicitly a research study.

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Acknowledgements:

The authors would like to thank the UNC Institute for Healthcare Quality Improvement, specifically Darren DeWalt, May-Britt Sten, Monecia Thomas, and Joy Martin, for their insight, feedback, and support. They would also like to thank Christopher Hurt for his HCV and e-consult expertise, as well as Greg Rochelle and Keyana Moss with UNC specialty services for their assistance with prior authorizations and MAP.

Funding

AJS received support from NIDA (K23DA049946).

Author information

Authors and Affiliations

  1. Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    L. Madeline McCrary MD, Mary Catherine Bowman MD, PhD, Briana Castillo MD, Jama M. Darling MD & Asher J. Schranz MD, MPH

  2. Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA

    L. Madeline McCrary MD, Christine Dunn, Robyn Jordan MD, PhD & Jane E. Young MSW

  3. Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, PA, USA

    Kate E. Roberts MA, MSW

Authors
  1. L. Madeline McCrary MD
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  2. Kate E. Roberts MA, MSW
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Correspondence to L. Madeline McCrary MD.

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McCrary, L.M., Roberts, K.E., Bowman, M.C. et al. Inpatient Hepatitis C Treatment Coordination and Initiation for Patients Who Inject Drugs. J GEN INTERN MED 38, 3428–3433 (2023). https://doi.org/10.1007/s11606-023-08386-y

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