Access to hepatitis C treatment for Veterans with serious mental illness
What is it about?
We analyzed VA VISN 5 administrative data to determine whether there were differences in access and adherence to sofosbuvir treatment for hepatitis C among Veterans with and without serious mental illness and related risk factors (e.g., alcohol use disorder, opioid use disorder, homelessness). We focused specifically on data from fiscal year 2016 because this was time at which the VA expanded hepatitis C treatment to all Veterans with a hepatitis C diagnosis, regardless of stage or strain of illness and other related risk factors. Our findings show that Veterans with serious mental illness were just as likely to start a sofosbuvir treatment regimen than Veterans without serious mental illness. Key differences were found among individuals with other risk factors (homelessness and alcohol use disorder) and their treatment initiation; Veterans who were Black (versus White), male, and had less than 50% service connection were more likely to initiate sofosbuvir-based hepatitis C treatment. In a basic analysis comparing those with and without serious mental illness, Veterans with serious mental illness were less likely to complete at least 8-weeks of sofosbuvir treatment; however, when additional variables were considered, this difference was no longer significant. Veterans who were older than 45 years of age and were more likely to complete at least an 8-week course of treatment. Veterans with an alcohol use disorder were less likely to complete at least 8 weeks of treatment.
Why is it important?
These findings are noteworthy in that they lend support to research and clinical findings that sofosbuvir is a safer and more effective hepatitis C treatment than older, interferon-based treatments. Individuals with serious mental illness, a group with some of the highest prevalence rates of hepatitis C and other infectious diseases, were largely excluded from hepatitis C treatments in the past due to concerns related to psychiatric side effects of interferon-based hepatitis C medications as well as provider concerns related to treatment adherence. These results are promising in that Veterans with serious mental illness, at least in this subset of the VA population, are receiving similar access to hepatitis C treatments as other Veteran groups. This can have major implications for not only integrated health care efforts within the VA system, but also can be helpful in managing hepatitis C infection and related health concerns in a population already at elevated risk for this and other physical health problems.