Still, some patients have been left out. The OIG conducted a study to, among other things, assess why some patients with chronic HCV infection were not treated with DAAs. Acceptable reasons included pregnancy, being in hospice or palliative care, the possibility of drug interactions with current medications, a diagnosis of liver cancer, and adherence challenges (eg, being homeless). Unacceptable reasons included HIV co-infection and prior treatment failure with DAAs.
The decision to disqualify a patient from receiving HCV treatment must be made on a case-by-case basis by individual providers in consultation with their patients, the OIG says. If a patient is deferred for treatment based on “problematic levels of alcohol or substance use,” the report adds, he/she should be referred for substance use treatment and must have a plan for re-evaluation for HCV treatment within 3 to 6 months. However, the VHA notes that patients with drug or alcohol addiction “should not be automatically excluded from hepatitis C treatment.”
The VA says it is on track to treat more than 125,000 veterans with HCV by October. As of March, fewer than 27,000 remained to be treated.