HCV Screening By Mail Effective Among VA Cohort

A universal screening approach that involves sending an automated letter may help identify prospective patients with hepatitis C virus (HCV) exposure and link them to care, according to results of a Veterans Affairs analysis.

With universal HCV screening now recommended in the US, investigators led by Lucas Harjono, PharmD, of the Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, sought to evaluate the effects of a screening program among veterans born between 1945 and 1965 who had no record of HCV antibody result within the last decade. The results were presented in a poster at IDWeek 2022, October 19-23, 2022, in Washington, DC.

Over 4 years, 12,875 letters were mailed to Veterans within the Veterans Affairs Greater Los Angeles Healthcare System. From this, 4,011 Veterans (31%) presented for HCV antibody testing. Ultimately, 4.2% who were tested were shown to be HCV antibody positive, and 41.3% of those individuals were shown to have the virus in their bloodstream.

Of those who were viremic, median age was 63; 49.3% were white and 26.1% were African American. Notably, 62.3% reported having stable housing, and patients lived a median of 27.9 miles away from the VA clinic. Among this group, 17.4% had cirrhosis, 10.1% reported opioid use disorder, and 29% reported alcohol use disorder.

Among the 69 patients who were viremic, 80% went on to Infectious Disease/Gastrointestinal follow-up appointment following referral. From there, 84% initiated treatment with HCV direct-acting antivirals (DAAs), 93% completed DAA treatment, and 93% achieved sustained virologic response (SVR).

Although nearly one-third of Veterans who received the letter participated in the HCV testing, follow-through for those who tested positive was negatively impacted by distance to the VA clinic, with a median of more than 61 miles and a max distance of nearly 98 miles among those who did not attend the first HCV visit. Notably, those who had stable housing and had cirrhosis were more likely to attend the first visit.

"Methods to facilitate remote evaluation and therapy, ie telehealth and e-consults will be important for those with marginalized housing status and who live distant to clinic," the investigators concluded.

For more coverage of IDWeek 2022, click here.