Tu1047 Assessing Key Barriers to Treatment of Chronic Hepatitis C Virus (HCV) With Next Generation Agents in a Veteran Population

Integrated Care Increases Treatment and Improves Outcomes of Patients With Chronic Hepatitis C Virus Infection and Psychiatric Illness or Substance Abuse

“…11 Interferon-free regimens have greatly simplified treatment; however, high costs, limited access to care, and concerns about compliance continue to represent barriers to treatment for patients with these comorbidities. 13,14 The data presented indicate that an IC protocol using midlevel mental health providers for patients with hepatitis C and substance use and psychiatric comorbidities is effective, resulting in higher antiviral treatment rates and a 2-fold increase in the numbers of patients with a SVR. The intervention was safe, with no significant differences in serious adverse events of death, hospitalization, and emergency room visits.…”

“…9,11,12 Recent data from one VA medical center indicated that 45% of current HCV patients are poor candidates for interferonfree treatment based on active psychiatric/SUD comorbidity, and Medicaid currently precludes patients with active SUD from receiving interferon-free medications in many states. 13,14 Integrated care (IC) refers to health care in which a variety of services are brought together to address interrelated health problems, and maximize patient compliance and outcomes. IC models have been effective in improving process measures and outcomes for treating psychiatric illness and substance use in primary care clinics and for improving treatment in acquired immune deficiency syndrome clinics.…”

HCV Integrated Care: A Randomized Trial to Increase Treatment Initiation and SVR with Direct Acting Antivirals

“…HCV-infected persons who are homeless, lack resources, and/or have ongoing substance use and psychiatric disorders may not readily engage in care or be adequately prepared to adhere to antiviral regimens without interventional assistance. For example, one recent VA study found that almost half of the HCV patients reviewed were poor candidates for interferon-free treatment based on psychiatric and substance use comorbidity [ 11 ]. Recently, a study tried to engage 481 consecutive HCV patients at high risk for advanced stage 3-4 fibrosis (FIB4 score > 2.4) in HCV care.…”

“…Evidence suggests that psychiatric comorbidity and/or substance use disorders (SUD) continue to be barriers to treating more people. A recent VA medical center study found that 45% of current HCV patients were deemed poor candidates for interferon-free treatment based on their comorbidity profiles (psychiatric and substance use disorders) [ 11 ]. Similarly, another medical center reported that 30% of treatment-eligible, high priority HCV patients most at risk for advanced fibrosis were unable or unwilling to engage in HCV care despite outreach efforts.…”

A Primary Care-based Collaborative Hepatitis C Clinic: Clinical Structure and Virologic Outcomes with Direct Acting Antiviral Therapy

“…Currently in most states Medicaid precludes the use of DAA in patients with ongoing substance abuse [25]. Recently, 45% of consecutive patients attending a HCV clinic at one VA medical center were considered to be poor candidates for interferon-free DAA treatment due to psychiatric and substance use issues that could affect compliance [26]. Teambased attempts to integrate a variety of services to address complex interrelated health problems have been shown to maximize adherence and outcomes in primary care studies related to substance abuse, depression, and HIV management.…”