Some 80% of veterans with hepatitis C who receive care through the Veterans Health Administration (VHA) initiated antiviral treatment, and 92% went on to achieve a functional cure, according to study findings published in Clinical Infectious Diseases. Younger veterans, however, were less likely to be treated and cured.

“Ongoing efforts are needed to reach younger veterans and veterans with unstable housing or substance use disorders,” wrote the researchers.

Hepatitis C virus (HCV) prevalence is higher among veterans compared with the general population. Cara Varley, MD, MPH, of the Oregon Health and Science University in Portland, and colleagues analyzed the HCV care continuum for people who receive care through the VHA.

The research team accessed the Veterans Affairs Corporate Data Warehouse for information on sex at birth, age, race, ethnicity and clinical data. The study population included people in all 50 states who were eligible to receive hepatitis C care through the VHA between January 2014 and December 2022. For this analysis, they included veterans who had at least one VHA visit in 2021 or 2022.

The researchers assessed the proportion of people who began direct-acting antiviral (DAA) therapy, achieved a functional cure (sustained virological response) and tested positive for HCV viremia again after successful treatment.

Most participants were white men who lived in urban areas. The researchers found that 133,732 people had detectable HCV viremia, indicating a need for treatment. Of this group, 107,134 (80%) began antiviral therapy. Among those treated, 98,136 (92%) achieved a functional cure. Among those who were cured, 1,097 (1.1%) tested positive for HCV RNA again, and 579 (53%) of them were treated once more.

The researchers observed that younger veterans were more hesitant to seek treatment and less likely to be cured but were more likely to experience viremia again. Furthermore, veterans with substance use issues and unstable housing were less likely to progress through various stages of the HCV care continuum. Achieving a functional cure was not linked to alcohol or opioid use.

“Repeat viremia is rare and is associated with younger age, unstable housing, opioid use and stimulant use,” according to the study authors.

“While the [VHA] is an integrated health system, many aspects of its approach could be implemented within other health systems and states, including a national push to eliminate prior authorization requirements and significantly reduce DAA pricing, state efforts to minimize barriers to HCV treatment (i.e., removal of cirrhosis requirements in order to receive DAAs), an active referral system to identify patients eligible for treatment, and collaboration with [substance use disorder], housing and mental health programs to facilitate testing, referral and treatment for HCV,” the researchers wrote.

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