1245. Outpatient Hepatitis C Management in Patients with Substance Use Disorder Following Hospital Admission for Severe Bacterial Infection

Abstract

Background Patients with substance used disorder (SUD) are at high risk of hepatitis c virus (HCV) infection. During admission for acute illness, patients with SUD are often screened for or known to have untreated chronic HCV with outpatient follow-up recommended. However, many barriers to HCV treatment exists including lack of insurance, no primary care provider (PCP), drug cost, and transportation. Therefore, we aimed to investigate HCV follow-up and treatment in patients with SUD post-hospitalization. Methods We performed a retrospective review of patients with SUD admitted for a severe bacterial infection between July 2015 and March 2020. A descriptive analysis was performed to evaluate patients with positive HCV testing instructed to follow-up outpatient for HCV treatment per discharge summary. We collected key information via chart review including location and attendance of follow-up as well as HCV testing and treatment status within two years of discharge. Results We identified 108 patients during the study period with chronic HCV in which 48 were recommended follow-up for outpatient HCV treatment (Table 1). 38 (79.2%) were recommended to follow-up with PCP and 10 (20.8%) with hepatology. 15 patients (31.2%) made their follow-up appointment. 30 patients (62.5%) had documented repeat HCV testing within two years of discharge. Of these, one (3.3%) was HCV antibody (Ab) only, 10 (33.3%) were HCV Ab plus viral load (VL), and 19 (63.3%) were HCV VL alone. 41 patients (85.4%) had no evidence of HCV treatment and 7 (14.6%) had documented clearance (4 confirmed treatment, 2 presumed treatment, and one documented treatment without confirmed testing). Of the 7 treated, 4 (57.1%) had a PCP prior to admission, whereas in the 41 untreated, 5 (12.2%) had a PCP. Table 1:HCV Follow-Up Outcomes Conclusion A low proportion of patients were confirmed to initiate and complete outpatient HCV therapy following hospital discharge. Many patients were lost to follow-up and had no repeat testing available. One-third of patients with repeat testing had repeat HCV Ab screen indicating an area for diagnostic stewardship. More pro-active approaches coordinating HCV therapy in patients with SUD requiring hospitalization for other infections are warranted in order to prevent unnecessary sequelae including HCV cirrhosis and carcinoma. Disclosures Monica K. Sikka, MD, F2G: Site research investigator.