February 29, 2024
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Key takeaways:
- Among 133,732 veterans with HCV, 80.1% initiated treatment and 91.6% achieved SVR.
- Younger veterans were less likely to initiate treatment and achieve SVR.
A Department of Veterans Affairs hepatitis C elimination program was overall successful in getting veterans with hepatitis C to initiate treatment and achieve sustained virologic response, researchers found.
“Many of the co-authors on this publication were involved with Veterans Affairs (VA) program to identify and treat veterans with chronic hepatitis C,” Cara D. Varley, MD, MPH, assistant professor at Oregon Health & Science University, told Healio.
Data derived from Varley CD, et al. Clin Infect Dis. 2024;doi:10.1093/cid/ciae025.
“VA’s hepatitis C elimination program, which began in 2015, shortly after the FDA approved highly effective oral medicines to cure hepatitis C, treated more than 100,000 veterans with hepatitis C. We undertook the current analysis to better understand the success of VA’s HCV elimination program 6 to 7 years after it started, and to identify potential gaps in the program that could be modified to further improve care,” she said.
Varley and colleagues assessed people receiving care from the Veterans Health Administration between 2021 and 2022 who were eligible for direct-acting antiviral (DAA) treatment from Jan. 1, 2014, through Dec. 31, 2022. According to the study, they evaluated the proportion of veterans who progressed through each step of the hepatitis C care continuum, and identified factors associated with initiating DAAs, achieving SVR and repeat hepatitis C viremia.
In total, the researchers identified 133,732 veterans with hepatitis C viremia. Treatment was initiated in 107,134 (80.1%) of these patients, with SVR achieved in 98,136 (91.6%). Among the patients who achieved SVR, 1,097 (1.1%) had repeat viremia and 579 (52.8%) underwent retreatment for hepatitis C.
After assessing factors associated with treatment initiation and SVR, the study showed that veterans of younger ages were less likely to initiate treatment and achieve SVR, and more likely to have repeat viremia. Stimulant use (OR = 0.85; 95% CI, 0.82-0.89), opioid use (OR = 0.92; 95% CI, 0.88-0.96), unstable housing (OR = 0.73; 95% CI, 0.70-0.76) and coinfection with hepatitis B (OR = 0.87; 95% CI, 0.78-0.98) were negatively associated with DAA treatment initiation, whereas stimulant use (OR = 0.78; 95% CI, 0.73-0.82) and unstable housing (OR = 0.63; 95% CI, 0.60-0.67) were negatively associated with SVR.
Based on these data, Varley said the VA was “incredibly successful” at its system-level, multifaceted approach to HCV care following DAA treatment availability, with many patients initiated on therapy and achieving SVR.
“This approach can serve as a model to improve HCV care in other health systems and provides additional data to support the elimination of prior authorization requirements and significantly reduce DAA pricing, efforts to minimize barriers to HCV treatment (i.e, removal of cirrhosis requirements in order to receive DAAs), a proactive referral system to identify people eligible for treatment, and collaboration with substance use disorder, housing and mental health programs to facilitate testing, referral and treatment for HCV,” Varley concluded.
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