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Engagement in Care of High-Risk Hepatitis C Patients with Interferon-Free Direct-Acting Antiviral Therapies

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Abstract

Background and Aims

The extent to which hepatitis C (HCV) treatment uptake is improved following introduction of interferon-free direct-acting antiviral (DAA) treatments is unknown. The purpose of this study was to determine HCV patient engagement and barriers to care for accessing DAA treatments in a real-world setting.

Methods

Patients with HCV viremia at high risk for fibrosis were identified using the Veterans Affairs (VA) registry within San Diego’s VA in October 2014. Patients not enrolled in HCV clinic were systematically contacted by letter and phone. Logistic regression was used to examine patient factors associated with subsequent engagement in care over 12–20 months.

Results

In the local registry of 2089 patients, 481 were identified with high-risk fibrosis scores. Of those, 380 (79%) were eligible for antiviral treatment, and 178/380 (47%) patients were actively followed in clinic. The remaining 202/380 (53%) patients were never seen by a HCV clinic provider or lost to follow-up. Of these, 114/380 (30%) of the treatment-eligible cohort remained non-engaged in care following outreach. Compared with patients engaged in care, non-engaged patients were significantly more likely to have homelessness, COPD comorbidity, or active alcohol or/and drug use. Overall 74.4% of patients engaged in HCV clinic received antiviral treatment.

Conclusions

A significant portion of eligible HCV patients could not be engaged in treatment after a programmatic outreach effort. These data indicate that more sustained or innovative outreach efforts are needed in order to maximize treatment access, with specific interventions targeting those with unstable housing and active alcohol/substance use disorders.

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Abbreviations

DAA:

Direct-acting antiviral

HCV:

Hepatitis C virus

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Acknowledgments

Research Service, VA San Diego Healthcare System, and Department of Veterans Affairs HSR&D Grant IIR 13-052-2.

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Authors and Affiliations

  1. Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA

    John B. Dever, Julie H. Ducom, Ariel Ma, Joseph Nguyen, Ann Herrin, Erik J. Groessl & Samuel B. Ho

  2. University of California, San Diego, CA, USA

    John B. Dever, Lin Liu, Erik J. Groessl & Samuel B. Ho

Authors
  1. John B. Dever
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  2. Julie H. Ducom
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  3. Ariel Ma
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  4. Joseph Nguyen
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  5. Lin Liu
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  6. Ann Herrin
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  7. Erik J. Groessl
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  8. Samuel B. Ho
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Correspondence to Samuel B. Ho.

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Conflict of interest

Samuel B. Ho: Research and grant support: Gilead Sciences; Consulting: Ventria, Inc.; Gilead Sciences, Inc.; Speakers Bureau: Prime Education, Inc., Abbvie, Inc. Other authors: no disclosures. This study was approved by Human Research Protections Program IRB and the Research and Development Committee of the VA San Diego Healthcare System.

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Dever, J.B., Ducom, J.H., Ma, A. et al. Engagement in Care of High-Risk Hepatitis C Patients with Interferon-Free Direct-Acting Antiviral Therapies. Dig Dis Sci 62, 1472–1479 (2017). https://doi.org/10.1007/s10620-017-4548-4

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  • DOI: https://doi.org/10.1007/s10620-017-4548-4

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