Inpatient Hepatitis C Treatment Coordination and Initiation for Patients Who Inject Drugs
Authors: L. Madeline McCrary, Kate E. Roberts, Mary Catherine Bowman, Briana Castillo, Jama M. Darling, Christine Dunn, Robyn Jordan, Jane E. Young, Asher J. Schranz
Source: Journal of Internal Medicine
Type of Publication: Article
Abstract:
Background
With hepatitis C (HCV) incidence rising due to injection drug use, people who inject drugs (PWID) are a priority population for direct-acting antivirals (DAA). However, significant barriers exist. At our institution, hospitalized PWID were screened for HCV but not effectively linked to care.
Aim
To improve retention in HCV care among hospitalized PWID.
Setting
Quaternary academic center in the Southeast US from August 2021 through August 2022.
Participants
Hospitalized PWID with HCV.
Program Description
E-consultation-prompted care coordination and HCV treatment with outpatient telehealth.
Program Evaluation
Care cascades were constructed to assess retention and HCV treatment, with the primary outcome defined as DAA completion or sustained virologic response after week 4. Of 28 patients, 11 started DAAs inpatient, 8 initiated outpatient, and 9 were lost to follow-up or transferred care. Overall, 82% were linked to care and 52% completed treatment. For inpatient initiators, 73% achieved the outcome. Of non-inpatient initiators, 71% were linked to care, 53% started treatment, and 36% achieved the outcome.
Discussion
Inpatient HCV treatment coordination, including DAA initiation, and telehealth follow-up, was feasible and highly effective for hospitalized PWID. Future steps should address barriers to inpatient DAA treatment and expand this model to other similar patient populations.