2206. In a non-urban Hepatitis C cohort, linkage to an infectious diseases clinic with embedded services is associated with better outcomes than linkage to a gastroenterology HCV clinic without these services for those with substance abuse.
Session: Poster Abstract Session: Hepatitis A, B, and C
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Sherbuk_IDWeek.pdf (560.0 kB)
  • Background: Hepatitis C virus (HCV) infection is now curable for most individuals and national goals for elimination have been established. Transmission remains ongoing, particularly in non-urban regions affected by the opioid epidemic. To reach elimination goals, barriers to treatment must be identified with a priority placed on those with substance abuse.

    Methods: In this retrospective cohort study of all individuals with chronic HCV from 2010-2016 at a large medical center serving a predominately non-urban population, we identified patient and clinic characteristics associated with our primary outcome, sustained virologic response (SVR). We performed a subgroup analysis for those with documented substance abuse.

    Results: SVR was achieved in 1544 (41%) of 3790 people with chronic HCV (Figure 1). In a multivariate Poisson regression model adjusted for patient demographics and year of diagnosis, SVR was less likely in those with substance abuse (IRR 0.8, 95% CI 0.7-0.9). In the subgroup analysis of those with substance abuse (N=682), SVR rates were higher in those linked to the infectious diseases clinic, which has embedded support services, than in those linked to gastroenterology, which does not (IRR 1.4, 95% CI 1.1-1.9) (Table). Higher SVR rates were driven by an increased rate of medication prescribing in those linked to infectious diseases (IRR 1.3, 95% CI 1.1-1.6) (Figure 2).

    Conclusion: Those with substance abuse, a high priority population for treatment of HCV, had better outcomes when receiving care in a clinic with embedded support services.

    Figure 1: Hepatitis C cascade of care

     

     

     

     

    Table: Factors associated with SVR in a multivariable Poisson regression model among those with substance abuse linked to care (N=458)

     

    Incidence Rate Ratio* (95% CI)

    P

    Hepatitis C Clinic

     

    Gastroenterology

    1 (ref)

    -

    Infectious Diseases

    1.4 (1.1-1.9)

    0.01

    Diagnosis Characteristics

    Outpatient Diagnosis

    1.5 (1.1-2.1)

    0.01

    * Incidence rate ratios are adjusted for patient demographics (age, sex, race, proximity to medical center, financial status, insurance type), diagnosis year and comorbidities (cirrhosis, hepatocellular carcinoma, HIV, hepatitis B) in addition to variables shown in table above.

     

     

    Figure 2: HCV cascade of care for those with substance abuse linked to care

     

    Jacqueline Sherbuk, MD1, Kathleen Mcmanus, MD, MSCR1, Elizabeth Rogawski, PhD, MSPH2, Terry Knick, RN, MPH1, Zachary Henry, MD3 and Rebecca Dillingham, MD, MPH1, (1)Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, (2)University of Virginia, Charlottesville, VA, (3)Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA

    Disclosures:

    J. Sherbuk, None

    K. Mcmanus, None

    E. Rogawski, None

    T. Knick, None

    Z. Henry, None

    R. Dillingham, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.