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Homeless veterans with HCV diagnosed, treated via PCP outreach
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WASHINGTON — Researchers identified a cohort of homeless veterans who successfully completed hepatitis C treatment and achieved sustained virologic response, including patients with polysubstance use, according to a presentation at Digestive Disease Week 2018.
Omar Bakr, MD, from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues were able to engage marginalized veterans who had previously been difficult to access with more traditional methods after integrating HCV care into the Homeless Patient Aligned Care Teams, or HPACT — an established interprofessional patient-centered medical home employed by the VA.
“Among house veterans, it has been estimated that 4% of them have hepatitis C infection; 80% of those patients will be diagnosed with hepatitis C and about 30% of them will be treated,” Bakr said during his presentation. “If you contrast that with homeless veterans, we have a much higher prevalence: about 13% infected with HCV; a higher rate of diagnosis, which may be surprising, about 90%; but a lower treatment rate with only about 20% of these patients being treated. This is the disparity we’re hoping to target with this project.”
To increase access to HCV care for homeless veterans, infectious disease specialists and primary care providers piloted a primary care-based, in-person and telemedicine treatment program with the West Los Angeles VA Medical Center.
During the program, primary care providers in the HPACT clinic received handouts and two to three didactic sessions with information on selection criteria and HCV treatment protocols.
The researchers identified 21 homeless veterans with HCV who met eligibility criteria, 10 of whom primary care physicians selected based on their engagement in medical care and likelihood to complete therapy. The other 11 were deferred for treatment.
At end of therapy, all 10 patients achieved sustained virologic response, which represented a 66.7% rate of treatment among the selected cohort. Bakr recognized the limitation of the small sample size, but noted that the results were encouraging based upon the engagement and 100% SVR outcome among the available patients.
“Our interprofessional model of PCP-specialist collaboration successfully engaged homeless veterans in HCV treatment with 100% SVR,” Bakr said. “There were not many differences between our treatment and defer treatment group, so further inclusiveness in treatment from the first referral may be warranted.” – by Talitha Bennett
Reference:
Bakr O, et al. Abstract 798. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosure: Bakr reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.
Perspective
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Paul Y. Kwo, MD
The VA system has been one of the most, if not the most, successful integrated health care system in implementing a program to eliminate chronic hepatitis C infection. In fact, the backlog of cases of untreated veterans who are engaged in the health care system has declined dramatically. Still, there are many patients remaining in the VA system who are marginalized.
In this pilot study, Bakr and colleagues collaborated with primary care physicians to select homeless veterans as candidates for hepatitis C treatment. While the number of treated veterans was small, 100% SVR rate was achieved. Given that the largest group of untreated hepatitis C patients in the VA system is the homeless population, this report outlines one strategy to try to ensure hepatitis elimination in all veterans, including those with limited resources. Hopefully, this strategy can be applied to a larger cohort and if successful scaled to other VA Hospital systems.
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