1. Success of the US Veterans Health Administration's Hepatitis C Virus Care Continuum in the Direct-acting Antiviral Era.
- Author
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Varley CD, Lowy E, Cartwright EJ, Morgan TR, Ross DB, Rozenberg-Ben-Dror K, Beste LA, and Maier MM
- Subjects
- Humans, Male, United States epidemiology, Female, Middle Aged, Aged, Hepacivirus drug effects, Viremia drug therapy, Hepatitis C, Chronic drug therapy, Hepatitis C, Chronic epidemiology, Adult, Veterans Health, Antiviral Agents therapeutic use, Continuity of Patient Care, Sustained Virologic Response, United States Department of Veterans Affairs, Veterans statistics & numerical data, Hepatitis C drug therapy, Hepatitis C epidemiology
- Abstract
Background: Estimated hepatitis C prevalence within the Veterans Health Administration is higher than the general population and is a risk factor for advanced liver disease and subsequent complications. We describe the hepatitis C care continuum within the Veterans Health Administration 1 January 2014 to 31 December 2022., Methods: We included individuals in Veterans Health Administration care 2021-2022 who were eligible for direct-acting antiviral treatment 1 January 2014 to 31 December 2022. We evaluated the proportion of Veterans who progressed through each step of the hepatitis C care continuum, and identified factors associated with initiating direct-acting antivirals, achieving sustained virologic response, and repeat hepatitis C viremia., Results: We identified 133 732 Veterans with hepatitis C viremia. Hepatitis C treatment was initiated in 107 134 (80.1%), with sustained virologic response achieved in 98 136 (91.6%). In those who achieved sustained virologic response, 1097 (1.1%) had repeat viremia and 579 (52.8%) were retreated for hepatitis C. Veterans of younger ages were less likely to initiate treatment and achieve sustained virologic response, and more likely to have repeat viremia. Stimulant use and unstable housing were negatively associated with each step of the hepatitis C care continuum., Conclusions: The Veterans Health Administration has treated 80% of Veterans with hepatitis C in care 2021-2022 and achieved sustained virologic response in more than 90% of those treated. Repeat viremia is rare and is associated with younger age, unstable housing, opioid use, and stimulant use. Ongoing efforts are needed to reach younger Veterans, and Veterans with unstable housing or substance use disorders., Competing Interests: Potential conflicts of interest. M. M. M. reports VA Portland Health Care System provides an annual stipend for continuing medical education (CME). C. D. V. reports funding unrelated to this work from Nontuberculosis Mycobacteria (NTM) Info and Research and National Heart, Lung, and Blood Institute (NHLBI) grant number K23HL161495. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
- Published
- 2024
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