The impact of psychosocial factors on the care cascade for hepatitis C treatment at a harm reduction program

Author: Daniel Burack, Daniel Winetsky, Pantelis Antoniou, Bill Garcia, Peter Gordon, Matthew Scherer

Theme: Models of Care Year: 2019

Direct-acting antiviral therapy (DAAT) is highly effective at achieving sustained virologic response (SVR)
among patients with chronic hepatitis C virus (HCV). However, people who inject drugs (PWID) face
significant barriers to DAAT access. Co-locating HCV treatment within with a harm reduction
organization has shown promise as a model for delivering DAAT to active PWID. Little is known about
the care cascade among patients treated for HCV in such co-located HCV treatment programs.
The Comprehensive Hepatitis Care on the Corner (CHOC) program co-locates HCV screening, evaluation
and treatment services within Washington Heights Corner Project (WHCP), a harm reduction
organization based in northern Manhattan, New York. We performed a retrospective chart review of all
CHOC patients with confirmed HCV viremia to assess the care cascade and identify factors associated
with progressing through the cascade to achieve SVR.
From December 2015 through December 2017, 78 patients completed intake in the CHOC program and
76 had an initial visit with a provider. Forty-seven patients were started on DAAT. Ten patients either
discontinued treatment, experienced a treatment interruption or were lost to follow up after initiating
therapy. Of the 37 patients who completed therapy, 34 (91.8%) achieved SVR. In a preliminary analysis,
having concurrent mental health treatment established at the time of intake was the only factor
associated with achieving SVR. Delay or interruption of treatment due to criminal justice involvement
was common but did not impact rate of SVR.
Co-location of HCV treatment within a harm reduction organization is a feasible model for providing
DAAT access to HCV-infected PWID. In this preliminary retrospective analysis, loss to follow up remained
a challenge throughout the care cascade, but among those who completed treatment the SVR rate was
high. Additional mental health resources may facilitate engagement in HCV treatment among this

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