A VA Perspective: The Expanding Role of the Clinical Health Psychologist in the New Era of Hepatitis C and Advanced Liver Disease Clinical Care

Abstract

The United States Department of Veterans Affairs (VHA) is the largest provider of Hepatitis C Virus (HCV) care and has made considerable effort in facilitating multidisciplinary medical and mental health care for Veterans with HCV. Those with HCV are at high risk for psychiatric and substance use disorders that often negatively impact selection for and completion of traditional antiviral treatments. Interferon-based treatments, which were difficult to tolerate due to toxicity and the high occurrence of side effects, were the previous standard for HCV treatment. New interferon-free agents with minimal side effect profiles and improved treatment responses have been developed, which results in more patients being treated for HCV. The VHA’s emphasis on multidisciplinary integration and person-centered care highlights the importance of integrating mental health care within HCV clinical care and provides a rich environment for expanding the role of the clinical health psychologist in hepatology settings. This paper will describe the role of the clinical health psychologist in the past and new era of HCV clinical care, with special consideration placed on the expanding role of the clinical health psychologist given the latest advancements in antiviral treatment for HCV. A review of the clinical health psychologist’s role in the following areas will be provided: assessment of treatment candidacy, treatment of mental health and substance use disorders, promotion of adherence, and work with specialty hepatology populations.