The Impact of Hepatitis C Anti Viral Therapy Initiative on Overall Health Maintenance

Abstract

Introduction: The Veteran's Administration is the largest provider of hepatitis C antiviral therapy (HCV AVT) in the US. VA underwent an intensive system redesign initiative allowing it to treat over 100,000 veterans in 3 years. When patients are approached for HCV AVT, bundling overall health maintenance measures to these encounters may further improve overall outcomes. Methods: We performed a cross sectional chart review of veterans with HCV being evaluated for novel anti-viral treatment from January 2014 through September 2017. Demographic and clinical data were collected. Outcome measures were implementation of preventative healthcare indices in patients being evaluated for HCV therapy. These include: referral for screening of colon cancer, lung cancer, bone mineral density, and vitamin D levels. Descriptive statistics were applied using SPSS v23®. Preliminary data is reported asmean ± SEM or as a percentage. Results: Of the 217 patients' charts reviewed, 97% were males with mean age (yrs) of 65 ± 0.41. 9.7% were coinfected withHIV with 0.9% hep B sAg + and 67.3% hep B cAb+. Mean FIB4 score was 3.2 ± 0.15. Overall SVR rate was 95% with1 patient missing SVR 12 due to death. With regards to colorectal cancer screening, 57.1% of patients completedscreening prior to HCV therapy evaluation and 40.5% had screening initiated during evaluation,35.9% completing theircolonoscopy. 33.2% had adenomatous polyps and 1% high grade dysplastic polyps. Of 51.3% of patients in whom lowdose CT was indicated, 10.6% completed this prior to evaluation while 23.6% were initiated duringintervention. Early stage lung cancer found in 1patient, 2 patients had liver lesions and 54.8% had lung nodules requiring follow up. Bone mineral density was applicable in 80.5% with only 16.7% completed priorto evaluation. BMD testing was initiated in 37.2% of the patients with 33% completion. 9.2% had osteoporosis and43.1% had osteopenia. In order to ascertain osteoporosis and osteopenia from osteomalacia (vit D deficiency), vit D level was evaluated in low BMD patients. The mean vit D (ng/mL) was 33 ± 1.77, 31 ±1.51 and 43 ±4.33 fornormal BMD, Osteopenia and osteoporosis, respectively. Conclusion: While evaluating patients with HCV with a goal to cure the virus, we found a substantial number of patients who are not receiving adequate preventative health measures. Bundling HCV AVT initiatives withgeneral key health screening measures can improve overall healthcare outcomes.