2194. Hepatitis B Care Cascade within the VA Maryland Health Care System
Session: Poster Abstract Session: Hepatitis A, B, and C
Saturday, October 6, 2018
Room: S Poster Hall
  • finalposter.pdf (809.2 kB)
  • Background: Approximately 730,000 Americans are estimated to have chronic hepatitis B (HBV) infection, but recent studies have identified gaps in HBV care. Our aim is to characterize the HBV care cascade at the Veterans Affairs Maryland Health Care System (VAMHCS).

    Methods: We used administrative VA data sources to identify patients enrolled at VAMHCS with a positive hepatitis B surface antigen (HBsAg) result within the VA from 10/1/99 through 2/7/18. Non-Veteran employees, Veterans who had died, or those with confirmed resolution of HBV infection were excluded. Chronic HBV infection was defined as a second positive HBsAg result or detectable HBV DNA >6 months later, or if included in the medical record. Resolved HBV infection was defined as undetectable HBsAg in someone with previously positive HBsAg.

    Results: We identified 159 patients with a history of detectable HBsAg; only 68 (43%) had confirmatory testing to verify chronic HBV infection. Most patients with confirmed HBV (90%) were male, Black (75%; 18% Caucasian, 5% Asian), with a mean age of 62 years (with standard deviation of ±12 years). Among patients with confirmed chronic HBV, 91% were seen by a provider at least once after diagnosis where HBV was addressed in the assessment and plan, 93% had e-Antigen testing, 41% had fibrosis staging (via transient elastography, liver biopsy, or FibroSure), 85% had at least one time screening for hepatocellular carcinoma (HCC), 100% had ALT testing at least once, 84% had ALT>upper limit of normal (men 30 U/L, women 19 U/L), 62% had HBV treatment at some point.

    Conclusion: This analysis reveals that within the Veteran population followed at the VAMHCS, less than half of those with initial detectable HBsAg have had confirmatory testing, and while the majority of patients with confirmed chronic HBV were by providers for HBV, less than half of patients received recommended fibrosis staging. More than half (62%) received treatment and the majority (84%) have had liver imaging at least once. The cascade of HBV care highlights multiple areas for targeted improvement of the care of Veterans with chronic HBV.

    Tyler Lambing, MD, University of Maryland, Baltimore, MD, Lydia Tang, MB, BCh, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, Lauren A. Beste, MD, MS, Primary Care Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, Anthony Amoroso, MD, University of Maryland School of Medicine, Institute of Human Virology, Baltimore, MD and Eleanor Wilson, MD, MHS, Infectious Disease, Department of Medicine, VA Maryland Health Care System, Baltimore, MD


    T. Lambing, None

    L. Tang, None

    L. A. Beste, None

    A. Amoroso, None

    E. Wilson, 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.