Assessment of hepatitis C monitoring adherence after viral eradication in veterans with substance use to improve care and surveil reinfection

• Main Authors: Miranda L. Stratton, PharmD (Author), Elayne D. Ansara, PharmD, BCPS, BCPP (Author), Amanda P. Ifeachor, PharmD, MPH, BCPS (Author), Kelly K. Houck, PharmD, BCPS (Author), Suthat Liangpunsakul, MD, MPH (Author), Katie J. Binger, PharmD, BCPP (Author)
• Format: Book
• Published: American Association of Psychiatric Pharmacists, 2022-06-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2168-9709; 10.9740/mhc.2022.06.181
• Keywords: hepatitis c virus; veterans; monitoring; substance use disorder; Neurosciences. Biological psychiatry. Neuropsychiatry; RC321-571; Pharmacy and materia medica; RS1-441
• Source: Mental Health Clinician, Vol 12, Iss 3, Pp 181-186 (2022)

Introduction: Hepatitis C virus (HCV) incidence rates are rising for patients with substance use and/or SUDs. Guidelines provide monitoring recommendations to ensure remission after successful treatment. The study's objective was to identify gaps in follow-up for patients with documented substance use and/or SUD through assessment of adherence to guideline-recommended HCV RNA lab 12 months post-treatment. Methods: Patients treated for HCV through the Veteran Health Indiana Hepatitis C Pharmacy Clinic were retrospectively evaluated. Subjects were categorized based on the provider assigned for follow-up care after 12-week sustained virologic response (SVR12) labs (primary care provider [PCP] or HCV provider). The primary outcome was HCV RNA obtained 11 to 13 months post-treatment. Secondary outcomes were HCV RNA detected post-treatment, substance use, engagement in substance use treatment, and engagement with social work. Results: Two hundred forty-one patients were included in the HCV provider cohort and 139 in the PCP cohort. Forty-one patients did not have a specified clinic for follow-up treatment, and 20 patients did not achieve SVR12. Sixty-one patients (28%) in the HCV provider cohort completed a 12-month HCV RNA within 11 to 13 months post-treatment vs 15 patients (11%) in the PCP cohort (P ≤ .01). One patient had HCV RNA detected post-treatment. Discussion: This study reveals inadequate HCV post-treatment follow-up for patients with substance use and/or SUD. SUD is a chronic disease that requires continued monitoring to prevent complications. Further studies are needed to identify reinfection rates and improvements of care in this population.