1055 Results of a Hepatitis C Outreach Initiative and Identification of Barriers to Treatment

Abstract

INTRODUCTION: Over 80% of veterans born between 1945-1965 in the Veterans Affairs system have been tested for hepatitis C (HCV). In December 2016 the Providence VA Medical Center implemented an outreach initiative that targeted veterans who were untreated for HCV. The purpose of this study is to evaluate the impact of the outreach program on HCV treatment initiation rates. The study also aims to identify factors associated with successful linkage to care and barriers to treatment. METHODS: Veterans with HCV viremia were targeted for outreach. Outreach entailed mailing letters to patients offering treatment, followed by telephone calls. The outreach team collaborated with primary care providers (PCP), social workers, the homeless clinic, and addiction services. Medical records were reviewed for demographics, disease characteristics and co-morbidities. The primary outcome was initiation of HCV treatment. Differences in characteristics between treated and untreated patients were studied to identify potential treatment barriers. RESULTS: 334 patients were treated for HCV prior to the start of the outreach initiative in December 2016. The outreach program targeted 175 patients with untreated HCV. Among these 175 patients, 116 (66.3%) were initiated on treatment, while 59 (33.7%) were not. Characteristics associated with treatment initiation include presence of psychiatric co-morbidities (P = 0.055), history of substance use (P = 0.03), and having a PCP located in-state (P = 0.02). Patients treated before the outreach initiative had higher rates of cirrhosis (P = 0.001), and higher APRI (P = 0.01), FIB-4 (P = 0.001), and Fibroscan scores (P = 0.001). CONCLUSION: The outreach program successfully initiated treatment in two-thirds of targeted patients. Prior to the program, HCV treated patients had higher rates of cirrhosis and more advanced liver disease based on non-invasive markers. This disparity may be related to increased screening in high-risk populations or a higher likelihood of establishment in the hepatology clinic. These findings suggest that outreach may improve access for patients who do not see a hepatologist. Higher rates of substance use and psychiatric disease in patients who were treated highlight the impact of coordinating care with mental health and addiction specialists. The data also shows that having a PCP out-of-state or not having a PCP listed is associated with non-treatment. Training more local providers in HCV management may aid in increasing treatment rates.