Receipt of alcohol-related care among patients with HCV and unhealthy alcohol use

Abstract

Background: Alcohol use—particularly unhealthy alcohol use—exacerbates risks associated with Hepatitis C virus (HCV). However, whether unhealthy alcohol use is appropriately addressed among HCV+ patients is understudied. We examined receipt of alcohol-related care among HCV+ patients and unhealthy alcohol use. Methods: All positive alcohol screens (AUDIT-C score ≥5) documented 10/01/09-5/30/13 were identified from national electronic health records data from the Veterans Health Administration (VA). Regression models estimated unadjusted and adjusted proportions of HCV+ and HCV- patients receiving 1) brief intervention within 14 days of positive screening, 2) specialty addictions treatment, and 3) pharmacotherapy for alcohol use disorder (AUD) in the year following positive screening. Adjusted models included demographics, alcohol use severity, and mental health and substance use disorder comorbidities. Results: Among 830,825 VA outpatients with positive alcohol screening, 31,841 were HCV+. Among HCV+, unadjusted and adjusted prevalences were 69.2% (CI, 68.7–69.6) and 71.9% (CI, 71.4–72.4) for brief intervention, 29.9% (CI, 29.4–30.4) and 12.7% (CI 12.5–12.9) for specialty addictions treatment, and 5.9% (CI, 5.7–6.1) and 3.3% (CI, 3.1–3.4) for pharmacotherapy, respectively. Among the 20,320 (64%) patients with HCV and documented AUD, unadjusted and adjusted prevalences were 40.0% (CI, 39.3–40.6) and 26.7% (CI, 26.3–27.1) for specialty addictions treatment and 8.1% (CI, 7.7–8.4) and 6.4% (CI, 6.1–6.6) for pharmacotherapy, respectively. Receipt of alcohol-related care was generally similar across HCV status. Conclusions: Findings highlight under-receipt of recommended alcohol-related care, particularly pharmacotherapy, among patients with HCV and unhealthy alcohol use who are particularly vulnerable to adverse influences of alcohol use.