Effective mail-based HCV testing among the VA cohort
A universal screening approach that involves sending an automated letter can help identify potential patients exposed to the hepatitis C virus (HCV) and link them to care, according to the results of a Veterans Affairs analysis.
With universal HCV screening now recommended in the United States, researchers led by Lucas Harjono, PharmD, of the Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, sought to assess the effects of a screening program among veterans fighters born between 1945 and 1965 who had no record of anti-HCV antibody result in the last decade. The results were presented in a poster at IDWeek 2022, October 19-23, 2022, in Washington, DC.
In 4 years, 12,875 letters were sent to veterans of the Greater Los Angeles Veterans Health System. From there, 4,011 veterans (31%) presented for HCV antibody testing. Ultimately, 4.2% of those tested tested positive for HCV antibodies, and 41.3% of those people had the virus in their bloodstream.
Among those who were viraemic, the median age was 63 years; 49.3% were white and 26.1% were African American. Notably, 62.3% reported having stable housing and patients lived a median of 27.9 miles from the VA clinic. Of this group, 17.4% had cirrhosis, 10.1% reported opioid use disorder, and 29% reported alcohol use disorder.
Of the 69 patients who were viraemic, 80% attended an infectious/gastrointestinal disease follow-up appointment after referral. From there, 84% started treatment with direct-acting antivirals (DAAs) for HCV, 93% completed treatment with DAAs, and 93% achieved a sustained virologic response (SVR).
Although nearly a third of veterans who received the letter participated in HCV testing, follow-up of those who tested positive was negatively affected by distance to the VA clinic, with a median of more than 61 miles and a maximum distance of almost 98 miles among those who did not participate in the first HCV visit. Notably, those in stable housing who had cirrhosis were more likely to attend the first visit.
“Methods to facilitate remote assessment and therapy, i.e. telehealth and electronic consultations, will be important for people who are marginalized and who live far from the clinic,” the investigators concluded.
For more coverage of IDWeek 2022, click here.