Background Although universal Hepatitis C Virus (HCV) Screening in the US was recommended in 2020, the optimal implementation method is unknown. We characterized the efficacy of an automated letter HCV screening program at the Veteran’s Affairs (VA) Greater Los Angeles Healthcare System (VAGLAHS) and evaluated associations with linkage to care. Methods From January 2017 to May 2020, 14,804 Veterans born between 1945-1965 who did not have an HCV antibody (Ab) test result within the last 10 years and who were within the VAGLAHS catchment area were identified. Veterans were mailed a letter recommending HCV screening via a centralized process. Veterans then used the letter to present to a VA laboratory for HCV Ab testing, which included reflex HCV viral load. Those who were HCV viremic were referred to Hepatology/Infectious Diseases clinics for initiation of HCV treatment. Baseline characteristics of those with subsequent HCV viremia were collected. To determine associations with the first HCV visit (linkage to care), we performed independent chi-squared tests. Flowchart of Automated Letter HCV Screening for Veterans Results A total of 12,875 Veterans were identified, 4,011 (31%) Veterans presented for HCV Ab testing, 167/4011 were HCV Ab + (4.2%), and 69/167 (41.3%) had HCV viremia. Of those viremic, 94 % were male, 26% were African-American, 62% had stable housing, 24% lived >90 miles from the nearest VA clinic, and 17% had cirrhosis. Fifty-five Veterans (80%) were evaluated in a viral hepatitis clinic and 84 % (46/55) initiated HCV treatment (Figure 1). Patients’ housing status (p = 0.02), cirrhosis (p< 0.0001), and distance to clinic (p=0.063) were associated with non-linkage to an initial HCV appointment. Conclusion One third of Veterans approached via mail participated in HCV Ab testing. Overall HCV Ab positivity rates were 4% and nearly half had HCV viremia. The majority of Veterans were linked to care but housing status, cirrhosis, and distance to clinic were associated with non-linkage to care. Automated letter screening is a promising approach to HCV screening, including universal screening. Future research should include investigations of telehealth and e-consults for linkage to care, especially for those who have marginalized housing status and live far from clinic. Disclosures Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
Background In 2020, the United States Preventive Services Taskforce recommended one-time Hepatitis C virus (HCV) screening for all adults aged 18-79. As the largest provider of HCV treatment in the US the Veterans Health Administration (VA) is committed to implementing these recommendations; thus, understanding perspectives of primary care teams towards this is critical. Methods We disseminated a 24-item online survey to PCPs at the VA Greater Los Angeles Healthcare System (VAGLAHCS), serving 1.5 million Veterans within an area that spans five counties. Our sample included physicians, pharmacists, nurse practitioners, and physician assistants on primary care teams. Our survey contained questions on demographics, provider knowledge of HCV testing, practice patterns and beliefs, and preferences for new screening tools. Descriptive statistics were completed and we compared item responses across demographics. Hypothesis testing was performed using Wilcoxon rank sum test for continuous variables and Fisher’s exact or Chi-square tests for categorical variables. Results In total, 107 PCPs responded to the survey (107/385=28% response rate), with 100 complete responses. Most respondents were women (63%) with median age of 42 years, physicians (53%), Internal Medicine-trained (47%), and of Asian descent (45%). A majority (59%) were aware of new screening recommendations. Most PCPs reported confidence (71%), intent (77%), and commitment towards (82%) HCV screening. Only 38% reported remembering to screen Veterans regularly. Physicians were most aware of new recommendations (73%), compared to pharmacists (55%) and nurse practitioners (42%). The most strongly preferred strategies to enhance screening included automatic test orders during physician visits (71%), automatic electronic-consults (68%), clinician reminders for HCV screening (57%), and opt-out phlebotomy (48%). Conclusion In a sample of providers within a large and diverse VA, 3 in 5 PCPs were aware of new universal HCV screening recommendations. There is high motivation among PCPs to perform screening, but forgetting to screen is still common. Several strategies to augment universal HCV screening were acceptable towards PCPs. Disclosures Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
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