Treatment for Hard-to-Reach Hepatitis C Patients May Improve with Integrated Care

The results of a new study, published in the International Journal of Hepatology, have shown that an integrated care (IC) program can be successful in providing treatment to patients infected with hepatitis C virus (HCV) who were unlikely to respond to traditional outreach efforts.

For the study, Erik Groessl, PhD, of the San Diego Veterans Affairs (VA) Healthcare System in San Diego, California, and colleagues at the San Diego VA, identified 79 subjects who had screened positive for HCV, as well as having symptoms of depression, post-traumatic stress disorder (PTSD), or substance use disorder. These comorbidities, along with homelessness, were prominent among factors associated with non-engagement in HCV care in previous VA studies.

Patients were randomized to an IC or Usual Care (UC) program to facilitate initiating and completing HCV treatment and attaining sustained viral response (SVR). The IC program consisted of brief psychological interventions and case management prior to and during HCV clinic treatment. The UC program followed VA treatment guidelines for required standard of care, with HCV clinic staff referring patients after screening to mental health and/or substance use clinics. Treatment of both groups within the clinic involved medication management and monitoring of response and risk factors.

According to the study, screening methods at the HCV clinic included a, “self-administered form screened for symptoms of depression (scores ≥10) on the Beck Depression Inventory (BDI), PTSD (endorsement ≥3 items) on VA Primary Care PTSD Screen, alcohol use (AUDIT-C) (scores ≥4), and self-reported active drug use in prior 6 months on the Drug Use Questionnaire (excluding marijuana). In addition, clinic staff checked medical records for positive urine toxicology in 6 months prior to baseline (excluding marijuana).”

The investigators reported that IC participants were twice as likely to initiate HCV treatment than those receiving UC (45%, versus 23%). The proportion of patients completing treatment and attaining SVR was the same in both groups. Intent-to-treat analysis with all randomized patients—including those who did not initiate treatment—estimated a 2.3 times greater rate of attaining SVR in the IC group (30%) than in the UC group (13%), although the difference was not statistically significant.

According to the authors, “The results presented support the use of IC strategies for optimizing the number of patients that successfully complete antiviral therapy while conserving limited resources.”