1244. Inpatient vs. outpatient initiation of Hepatitis C treatment among hospitalized patients who inject drugs: Lessons from a quality improvement project


 
 
 Hepatitis C (HCV) diagnoses are rising, driven by infections in people who inject drugs (PWID). PWID are identified as a target population for treatment, but access to care is a barrier. At our institution, Addiction Medicine (AM) and Infectious Diseases (ID) routinely screen hospitalized PWID for HCV. Our novel quality improvement project assessed feasibility of starting HCV care processes for PWID inpatient. This included: (1) inpatient e-consults, (2) inpatient treatment initiation with direct acting antivirals (DAAs) when possible, and (3) post-discharge telehealth care.
 
 
 
 The project was implemented at an academic hospital in the Southeast in August 2021, with results observed through April 2022. Patients seen by AM consultants with detectable HCV RNA and interest in treatment were eligible. AM recommended ID e-consults focused on HCV care, which began care coordination, including inpatient treatment initiation in select cases (based primarily on length of stay) (Fig 1). The primary outcome was “likely cure,” defined as treatment completion or SVR-4 (chosen due to concerns for loss to follow up). Cascades of care were constructed including: (1) completed HCV e-consult; (2) linkage to care (defined as telehealth visit for those not initiating inpatient); (3) treatment initiation; and (4) likely cure. Figure 1:Workflow
 
 
 
 Twenty patients had detectable HCV RNA and all were interested in treatment. Enrolled patients had a mean age of 33 years; 9/20 (45%) were female; and 17/20 (85%) were White. Of 20 patients (Fig 2), 16 (80%) were linked to care with 13 (81%, 65% overall) started on HCV treatment, of which 9 were started inpatient. Likely cure was achieved for 7, and 6 were still on treatment at the time of this report (Fig 2). Likely cure has so far been achieved in 66% of inpatient initiators (6 of 9), compared with 18% of others (2 of 11) (Figs 3 and 4). 6 patients were lost to follow-up. None of those initiating DAAs inpatient were lost.
 
 
 
 Inpatient initiation of HCV treatment for PWID was feasible for patients with prolonged hospitalizations and may be effective at facilitating HCV treatment and cure among a vulnerable population with substantial barriers to care. Future steps should address inpatient barriers to DAAs, and examine models of HCV telehealth.
 
 
 
 Asher J. Schranz, MD, MPH, UnitedHealthCare: Honoraria.
