title: Engagement in Care of High-Risk Hepatitis C Patients with Interferon-Free Direct-Acting Antiviral Therapies.
abstract: The extent to which hepatitis C (HCV) treatment uptake is improved following introduction of interferon-free direct-acting antiviral (DAA) treatments is unknown. The purpose of this study was to determine HCV patient engagement and barriers to care for accessing DAA treatments in a real-world setting.
  
  
  
  Patients with HCV viremia at high risk for fibrosis were identified using the Veterans Affairs (VA) registry within San Diego's VA in October 2014. Patients not enrolled in HCV clinic were systematically contacted by letter and phone. Logistic regression was used to examine patient factors associated with subsequent engagement in care over 12-20 months.
  
  
  
  In the local registry of 2089 patients, 481 were identified with high-risk fibrosis scores. Of those, 380 (79%) were eligible for antiviral treatment, and 178/380 (47%) patients were actively followed in clinic. The remaining 202/380 (53%) patients were never seen by a HCV clinic provider or lost to follow-up. Of these, 114/380 (30%) of the treatment-eligible cohort remained non-engaged in care following outreach. Compared with patients engaged in care, non-engaged patients were significantly more likely to have homelessness, COPD comorbidity, or active alcohol or/and drug use. Overall 74.4% of patients engaged in HCV clinic received antiviral treatment.
  
  
  
  A significant portion of eligible HCV patients could not be engaged in treatment after a programmatic outreach effort. These data indicate that more sustained or innovative outreach efforts are needed in order to maximize treatment access, with specific interventions targeting those with unstable housing and active alcohol/substance use disorders.
authors.affiliation: Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.|University of California, San Diego, CA, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Dever
authors.affiliation: Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
authors.forename: Julie H
authors.initials: JH
authors.lastname: Ducom
authors.affiliation: Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Ma
authors.affiliation: Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Nguyen
authors.affiliation: University of California, San Diego, CA, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Herrin
authors.affiliation: Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.|University of California, San Diego, CA, USA.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Groessl
authors.affiliation: Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. samuel.ho2@va.gov.|University of California, San Diego, CA, USA. samuel.ho2@va.gov.
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Ho
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D000998:Antiviral Agents / Q000627:therapeutic use*; D015897:Comorbidity; D015709:Correspondence as Topic; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006798:Housing; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012042:Registries; D012307:Risk Factors; D013689:Telephone
chemical_list: D000998:Antiviral Agents
keywords: Cirrhosis; Direct-acting antivirals; FIB-4; Hepatitis C virus; Linkage to care