As the largest provider of care for patients with chronic hepatitis C virus (HCV) infection in the United States, the Veterans Health Administration (VHA) is in a unique position to address the challenges posed by the disease. As I discuss in more detail in this supplement, the VHA has made a substantial commitment to providing HCV care, and the results of that commitment have led to improved outcomes for thousands of individuals.
By the end of 2016, more than 70% of veterans in the 1945-1965 birth cohort had been screened for HCV. Once identified, however, these patients need to be guided to ensure that they make (and keep) follow-up appointments, fill prescriptions, and complete their course of treatment—a process known as linkage to care. As Dr. Ross et al explain in their article, the Department of Veterans Affairs (VA) has established Hepatitis C Innovation Teams that use a data-driven approach to establish an efficient path to screening, diagnosis, and treatment. Readers will discover strategies they can implement in their own practices and centers to improve outcomes in their patients with HCV.
For years, clinicians committed to the treatment of patients with HCV have been frustrated by the lack of efficacy of available drugs. The clinical picture changed radically with the advent of direct-acting antiviral (DAA) agents, which allow for shorter treatment durations, fewer side effects, and result in very high rates of sustained virologic response after just 12 weeks, even in patients with compromised renal function or cirrhosis. Seldom in medicine are we able to use the term “cure,” but use of the right DAAs against the right HCV genotype in the right patients leads to cure in roughly 95 out of 100 cases. In her article, Dr. Belperio succinctly summarizes the various available DAA regimens and the factors that drive selection of treatment to optimize outcomes.
Management of patients with HCV is not solely a question of eradicating the virus. Complications such as infections, hepatocellular carcinoma, and psychiatric and substance abuse disorders must also be addressed as part of the overall treatment strategy. Dr. El-Serag’s section of this supplement reviews the most common long-term complications of HCV and describes successful strategies developed and deployed within the VA system for monitoring—and mitigating—these concerns.
Despite recent achievements, there are still opportunities to improve the treatment of patients with HCV within the VHA. The information in this supplement will provide clinicians with evidence-based, practical strategies for achieving this important goal.
Alexander Monto, MD, Chair
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Participants should read the activity information, review the activity in its entirety, and complete the online posttest and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a Web page that will allow you to receive your certificate of credit via e-mail or you may print it out at that time.
The online post-test and evaluation can be accessed at: http://tinyurl.com/HCVA17
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The prevalence of chronic HCV infection among patients in the Veterans Health Administration (VHA) is approximately 4 times that of the general population. Approximately 50,000 US military veterans are infected with HCV, but their infection has not been diagnosed. The VHA is uniquely suited to treat HCV infection as well as to address its significant mortality and morbidity. However, infected veterans—as well as the VHA clinicians who manage these patients on a regular basis—face many barriers to diagnosis, testing, and treatment, barriers that in many ways are unlike those encountered in the private sector. To address those barriers, in recent years the VHA has made a substantial commitment to providing HCV care, as reflected in expanded funding, the establishment of Veterans Integrated Service Network–level HCV Resource Centers and Hepatitis C Innovation Teams (HITs), and other steps aimed at providing efficient, effective care. The expanding armamentarium of direct-acting antiviral (DAA) agents for HCV infection means that approximately 95% of treated individuals can experience sustained virologic response—essentially, a cure. Clinicians within the Department of Veterans Affairs (VA) system need education to raise their awareness of screening protocols, the need to evaluate HCV genotypes and the possible presence of resistance-associated polymorphisms, the selection of often complex drug regimens, and the importance of managing comorbidities, including psychiatric illness, substance abuse-related problems, and liver conditions such as cirrhosis and hepatocellular carcinoma.
At the conclusion of this program, participants should be better able to:
- Recognize the special characteristics of the patient population with chronic HCV infection whose care is managed within the US VHA, including risk factors and medical and psychiatric comorbidities
- Identify opportunities for improving HCV screening, diagnosis, and testing among the veteran population
- Develop comprehensive individualized management strategies for patients with chronic HCV infection
- Compare and contrast risks and benefits of currently available drug regimens for treating chronic HCV infection
- Describe practical approaches for improving the continuum of care for veterans with chronic HCV infection.
Global Education Group requires instructors, planners, managers, and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global Education Group for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Alexander Monto, MD, Chair; Dr Monto’s wife has been a consultant for Gilead Sciences, Inc.
Pamela S. Belperio, PharmD, BCPS, has nothing to disclose.
Hashem B. El-Serag, MD, MPH; Grant/Research Support: Gilead and Wako Pure Chemical Industries, Ltd.
Rachel Gonzalez, MPH, has nothing to disclose.
Fasiha Kanwal, MD, MSHS; Grant/Research Support: Gilead.
Timothy Morgan, MD; Grant/Research Support: Abbvie Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Genentech, Gilead, Hoffman-LaRoche, Merck & Co.
Angela Park, PharmD, CACP, has nothing to disclose.
David B. Ross, MD, PhD, MBI, has nothing to disclose.
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Global Academy for Medical Education Staff: Sylvia H. Reitman, MBA, DipEd; Mike LoPresti; Shirley V. Jones, MBA; Ron Schaumburg; Tom Garry; and Suzanne Bujara hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
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