2230. Treatment Outcomes for Hepatitis C Patients from Two Federally Qualified Community Health Centers in South Carolina

Abstract

Background. Approximately 3.9 million Americans live with chronic Hepatitis C virus (CHCV). Major advances have been made in the treatment of CHCV, with the availability of oral directly acting antiviral (DAA) regimens. However, significant barriers to treatment remain for patients accessing safety net providers for care. In 2011, 61,294 Community Health Center (CHC) patients had Hepatitis C as their primary diagnosis. This study provides insight into unique CHC patient characteristics and outcomes of care at two federally qualified health centers (FQHC). Methods. We queried electronic health records (EHR) from Q4 2014 to Q1 2018 for Hep C patients attending two FQHCs in South Carolina (n = 223). Data from both practices were aggregated to capture sustained virologic (SVR) rates at 12 weeks post treatment. Patient demographic factors, including age; gender; race/ethnicity, insurance status and people who inject drugs (PWID) were extracted. Clinical measures such as baseline and post treatment viral loads, Fibrosure, AST to Platelet Ratio Index (APRI) measures, pre treatment and post treatment liver ultrasound screening, HCV genotype, and HIV co-infection are reported. Patient outcomes were monitored using SVR viral load values (detectable or nondetectable) at 12 weeks and 1 year from treatment onset. Results. Mean age was 57.03 SD +/- 0.65 with 71.7% of the population treated aged 55 or older. Most patients were males (63.2%), African American (68.2%) and uninsured (31.4%). Median baseline HCV viral load was 1,950,000 IU/mL. About 95.9% of the patients were naive to Hepatitis C treatment. Majority of Fibrosure stages (F0-F2 48.9%; and F3-F4 37.2%) and APRI scores both showed about half of patients presented with little likelihood of liver cirrhosis. Post-liver ultrasound occurred in 37.7% of the population. Top three genotypes were 1a (67.3%), 1b (17.5%) and 2b (5.8%). The proportion of PWID among those responding was 23.4%. HIV coinfection in the population sample was 29.1%, while the SVR VL was nondetectable for 97.6%. Conclusion. Overall, FQHCs served the CDC target baby boomer population age group. Findings show Hepatitis C treatment can be successfully undertaken at FQHCs including difficult to treat populations such as PWID. The SVR viral load shows efficacy of treatment at both FQHCs.