Review of Hepatitis C Virus Care within the Veterans Health Administration

The Veterans Health Administration (VHA) is the nation’s largest care provider for chronic hepatitis C virus infection, with rates about three times the national average. Direct-acting antivirals (DAA) can cure chronic hepatitis C, and Congress appropriated over $3 billion between fiscal years 2015–2017 to provide such treatment for infected veterans. The VA Office of Inspector General (OIG) conducted this review to assess VHA facilities’ care of patients with chronic hepatitis C. In one study population, the OIG found that 8,813 (55 percent) of 15,940 patients who tested positive for chronic hepatitis C did not receive DAA treatment. VHA providers documented acceptable reasons for nontreatment for 85.5 percent of these patients. Acceptable reasons included when the patient received treatment outside VHA, deferred or declined treatment, or did not respond to contact attempts by VHA. Other patients did not receive treatment for reasons that were unidentifiable (11.6 percent) or indeterminate (2.9 percent) to the OIG, hindering its ability to evaluate providers’ plans to offer these patients treatment or specialty care referrals. The OIG also found that 9.6 percent of patients who completed DAA treatment did not receive posttreatment testing to confirm they were cured, although the OIG was unable to determine the reasons why testing was not done. In a second study population of 5,467 patients, the OIG assessed whether those who tested positive for hepatitis C antibodies received further confirmatory testing for chronic hepatitis C infection as required. An estimated 99.1 percent of these patients had confirmatory testing completed. The OIG made two recommendations to the VHA Executive in Charge to ensure patients with chronic hepatitis C have provider treatment considerations documented and that providers obtain and document posttreatment follow-up testing in the patients’ medical record in alignment with VA National Viral Hepatitis Program Guidelines.