Methods: We used a population-level electronic health record to extract information on HCV viremic patients in the Greater Los Angeles VAMC from May 2013 to May 2015. Advanced fibrosis was defined as a FIB4>3.25. The cascade of care was defined as 1) HCV viremic veterans, 2) number referred for specialty care, 3) number evaluated in clinic, 4) number treated, and 5) number with SVR. Referrals were defined as a referral to an ID/GI clinic and evaluation for treatment was met if the patient attended an ID/GI clinic appointment.
Results: There were 4538 veterans with HCV viremia, of these 3230 (71%) were referred to hepatitis C care, 1624 (36%) were evaluated for treatment, 949 (21%) received therapy, and 449/4538 (10%) achieved a sustained virologic response (SVR12). Advanced fibrosis was present in 801/4538 (18%) of HCV viremic patients; of whom 632 (79%) were referred for care, 309 (39%) were evaluated for treatment, 201(25%) received therapy, and 68 (8.0%) had an SVR12.
Conclusion: In a single-center VAMC, the majority of HCV viremic veterans are referred to HCV care but only 36% and 21% are evaluated for treatment and received treatment, respectively. Once evaluated, >50% patients received treatment. Rates were similar in those with advanced fibrosis. Potential barriers in linkage to care may include distance from clinic and gaps in patient education. Identifying barriers to care and designing targeted interventions will be important in ensuring treatment for HCV infected veterans, particularly those with advanced fibrosis.
Bristol Myers Squibb:
Abbvie: Collaborator , Research support
T. Hoang, None
W. A. Schwartzman, None
A. Sheinbaum, Gilead: Collaborator , Research support
P. Belperio, None
M. Bidwell Goetz, None