Pamela S. Belperio, PharmD; Maggie Chartier, PsyD, MPH; David B. Ross, MD, PhD, MBI; Poonam Alaigh, MD; David Shulkin, MD
Acknowledgment: The authors thank Dr. Lisa Backus for her contributions related to the generation of data used for reporting HCV testing rates, treatment rates, and cascade-of-care steps.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1073.
Requests for Single Reprints: Pamela S. Belperio, PharmD, Patient Care Services/Population Health Services, VA Palo Alto Health Care System, 3801 Miranda Avenue (132), Palo Alto, CA 94304; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Belperio: Patient Care Services/Population Health Services (10P4V), Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue (M/C 132), Palo Alto, CA 94304.
Dr. Chartier: HIV, Hepatitis and Related Conditions, Office of Specialty Care Services (10P11I), Department of Veterans Affairs, San Francisco VA Medical Center, 4150 Clement Street (116B), San Francisco, CA 94121.
Dr. Ross: HIV, Hepatitis and Related Conditions, Office of Specialty Care Services (10P11I), Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420.
Dr. Alaigh: Office of the Under Secretary for Health, Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420.
Dr. Shulkin: Secretary of Veterans Affairs, Office of the Secretary for Health, Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420.
Author Contributions: Conception and design: P.S. Belperio, D.B. Ross, P. Alaigh, D. Shulkin.
Analysis and interpretation of the data: P.S. Belperio, M. Chartier, P. Alaigh, D. Shulkin.
Drafting of the article: P.S. Belperio, M. Chartier, D. Shulkin.
Critical revision of the article for important intellectual content: P.S. Belperio, M. Chartier, P. Alaigh.
Final approval of the article: P.S. Belperio, M. Chartier, D.B. Ross, P. Alaigh, D. Shulkin.
Obtaining of funding: D.B. Ross, D. Shulkin.
Administrative, technical, or logistic support: M. Chartier, D.B. Ross.
Collection and assembly of data: P.S. Belperio.
The U.S. Department of Veterans Affairs (VA) is the nation's largest care provider for hepatitis C virus (HCV)–infected patients and is uniquely suited to inform national efforts to eliminate HCV. An extensive array of delivery of services, policy guidance, outreach efforts, and funding has broadened the reach and capacity of the VA to deliver direct-acting antiviral (DAA) HCV therapy, supported by an infrastructure to effectively implement change and informed by extensive population health data analysis. The VA has treated more than 92 000 HCV-infected veterans since all-oral DAAs became available in January 2014, with cure rates exceeding 90%; only 51 000 veterans in VA care are known to remain potentially eligible for treatment. Key actions advancing the VA's aggressive treatment of HCV infection that are germane to non-VA settings include expansion of treatment capacity through the use of nonphysician providers, video telehealth, and electronic technologies; expansion of integrated care to address psychiatric and substance use comorbidities; and electronic data tools for patient tracking and outreach. A critical component of effective implementation has been building infrastructure through the creation of regional multidisciplinary HCV Innovation Teams, whose system redesign efforts have produced innovative HCV practice models addressing gaps in care while providing more efficient and effective HCV management for the populations they serve. Financing for HCV treatment and infrastructure resources coupled with reduced drug prices has been paramount to the VA's success in curing HCV infection. The VA is poised to share and extend best practices to other health care organizations and providers delivering HCV care, contributing to a concerted effort to reduce the overall burden of HCV infection.
Belperio PS, Chartier M, Ross DB, et al. Curing Hepatitis C Virus Infection: Best Practices From the U.S. Department of Veterans Affairs. Ann Intern Med. 2017;167:499–504. [Epub ahead of print 26 September 2017]. doi: 10.7326/M17-1073
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Published: Ann Intern Med. 2017;167(7):499-504.
Published at www.annals.org on 26 September 2017
Gastroenterology/Hepatology, Infectious Disease, Liver Disease, Viral Hepatitis.
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