Automatic Letters Help Boost Screenings for Hepatitis C


About a third of veterans who received a letter to get tested for hepatitis C did so, according to a study by the Veterans Affairs Greater Los Angeles Healthcare System.

Automated letters implemented as part of a hepatitis C virus screening program lead to about a third of recipients getting screened for the virus, according to investigators from the Veterans Affairs Greater Los Angeles Healthcare System. Their study was developed into a subsequent poster, “Analysis of an Automated Letter HCV Screening Program within a Veterans Affairs Health System: Implications for Universal HCV Screening” which was presented at the recent ID Week 2022.

The investigators mailed letters to veterans in order to characterize the efficiency of an automated letter HCV screening program at the VA and its associations with care. Veterans received these letters between January 2017 to May 2020 if they were born between 1945 and 1965 and did not have a hepatitis C antibody test result on file within the last 10 years. The study authors said that despite a US recommendation for universal hepatitis C screening, the optimal delivery method is unknown.

Once veterans received the letter, they used it to present to a VA laboratory for hepatitis C Ab testing, including reflect hepatitis C viral load, the study authors explained. Those who had hepatitis C had some baseline characteristics collected and were referred to hepatology or infectious disease clinics to initiate treatment.

The study authors identified 12,875 veterans, of which 4,011 presented for hepatitis C Ab testing (about a third), they said. Of those who were tested, 4.2 percent were hepatitis C Ab + and 41.3 percent had hepatitis C viremia (69 patients).

Almost all of the viremic patients were male (94 percent), about a quarter were African-American (26 percent), most had stable housing (62 percent), a quarter lived more than 90 miles from the nearest VA clinic (24 percent), and 17 percent had cirrhosis, the study authors observed. The median page was 63 years. The study authors also noted 10 percent of the viremic patients had an opioid use disorder and 29 percent had an alcohol use disorder.

Nearly all of the viremic patients–94 percent–were treatment naïve, the study authors added.

When characterizing the efficiency of the letters, the study authors defined the first hepatitis C visit as the first clinical visit to a hepatology or infectious disease specialty clinic for evaluation or treatment. With that said, 55 veterans were evaluated in a viral hepatitis clinic and 84 percent of those patients initiated hepatitis C treatment.

From there, the study authors learned that almost all of the patients who initiated treatment completed hepatitis C direct-acting antivirals and a majority of those patients made it to sustained virologic response.

Reasons for not creating an initial appointment included patients’ housing status, cirrhosis, and distance to the clinic, the investigators determined.

“Automated letter screening is a promising approach to HCV screening, including universal screening,” the study authors concluded. “Future research should include investigations of telehealth and e-consultsfor linkage to care, especially for those who have marginalized housing status and live far from clinic.”

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