Patients with chronic hepatitis C receiving primary care at federally-qualified health centers (FQHCs) often have co-occurring behavioral health conditions, including mental health, substance use and chronic pain diagnoses, which make providers reluctant to offer hepatitis C treatment. Despite increased access to hepatitis C direct-acting antivirals at FQHCs, few studies look at the characteristics and treatment outcomes for such patients. We aim to evaluate outcomes for patients with mental health, substance use and chronic pain diagnoses treated for hepatitis C by primary care providers (PCPs) in non-academic, non-specialist, community health center settings serving a low-income urban population.
We collected diagnosis, treatment and lab data from the medical records of patients treated for hepatitis C by PCPs at four FQHCs from January 2015 to July 2016. Patients with depression, anxiety, psychotic or organic brain disorders were considered to have a mental health diagnosis. Patients with illicit drug or excessive alcohol use were considered to have a substance use disorder. Medication regimens were determined by PCPs according to guidelines and obtained through usual processes. No study drugs or additional behavioral health staff were provided.
182 patients completed treatment for hepatitis C with PCPs at the four FQHCs from January 2015 to July 2016. Their genotypes include 1a/b, 2, 3, 4, and 6; 83% had genotype 1. 96% of the 112 patients with a viral load result at least 12 weeks after treatment completion had undetectable viral loads (SVR12). 64% of these patients had co-occurring mental health, substance use and/or chronic pain diagnoses; their SVR12 rate was 94%. There were four treatment failures among patients with behavioral health conditions and one treatment failure among patients without. Two patients stopped treatment early or were lost-to-follow-up, both with mental health conditions and chronic pain. Based on an intention-to-treat analysis, the overall SVR12 rate for this cohort was 94%. No statistically significant differences were found at the p<0.05 level. Please refer to the table for details.
These data demonstrate that patients with co-occurring mental health, substance use, and chronic pain diagnoses can achieve similar rates of hepatitis C cure as those without these behavioral health conditions when treated by PCPs in ‘real world,’ non-academic, non-specialist, community health center settings.