(86) Enhancing Viral Hepatitis Harm Reduction through a Comprehensive Addiction Consult Service

Background & Introduction: When care is delivered in a person-centered, non-stigmatizing environment, hospitalization for acute medical disease represents an opportunity to initiate substance use treatment and infectious disease screening for people who use drugs. Regardless of age or setting prevalence, all persons with risk factors should be tested for hepatitis C, with routine periodic testing while risk factors persist. Treating people who use drugs can reduce transmission of hepatitis C and provide community-level prevention for new infections. Since 1996, the U.S. Centers for Disease Control and Prevention has recommended hepatitis A vaccination has for persons who use injection or non-injection drugs, and hepatitis B vaccination is recommended for all unvaccinated adults at risk for infection including persons with a history of current or recent injection drug use. We set out to assess the impact of an addiction consult initiated infectious disease screening panel of labs for hepatitis A, hepatitis B, and hepatitis C, as well as initiation of hepatitis A and hepatitis B vaccine series and hepatitis C treatment when appropriate.

Methods: This retrospective, pre-post quality improvement study was performed at a large urban academic hospital in Philadelphia PA comparing data from February 1, 2023-November 30, 2023, prior to the intervention, to data from February 1, 2024-November 30, 2024, after the intervention. The study population included all patients who received an addiction medicine consult from Feb-Nov 2023 and 2024. The process measures included hepatitis C antibody and subsequent PCR for quantitative RNA analysis for patients with a reactive antibody because we had observed many patients with a reactive screening antibody test who had a missing PCR test to confirm the presence of ongoing chronic disease that would make the patient a candidate for treatment. The hepatitis A total antibody and hepatitis B triple screen (surface antigen, surface antibody, and core IgG antibody) were selected as process measures because we had observed few patients being screened for vaccination candidacy. The outcomes included the number of patients started on direct-acting antiviral medications for treatment of chronic hepatitis C and the number of patients receiving at least one vaccination to prevent hepatitis A and/or hepatitis B.

Results: Quantitative data were drawn from the electronic health records to assess the viral testing process measures, followed by statistical analysis using odds ratios. The data used to assess the outcome of vaccination was similarly drawn from electronic health records and analyzed as a percentage of eligible patients vaccinated. A pharmacy report was run to identify patients receiving hepatitis C treatment medications followed by a brief chart review to ensure inclusion of only those who had received an addiction medicine consult, then also analyzed as a percentage of eligible patients initiated on treatment. There were a total of 1055 patients included: n = 565 for the pre-intervention period and n = 490 for the post-intervention period. The odds ratios for having viral testing for hepatitis A = 5.1, (p <.001), hepatitis B = 3.1 (p < .001) and hepatitis C = 2.10 (p <.001). Pre-post numbers for hepatitis A vaccination were 2 (0.4%) and 19 (1.8%), for hepatitis B vaccination were 8 (1.5%) and 28 (6.5%), and for hepatitis C treatment 0 (0.0%) and 15 (17.4%).

Conclusion & Discussion: We significantly increased screening for hepatitis A and B vaccine eligibility, as well as hepatitis C treatment. Initiating hepatitis A and B vaccines have not a priority during hospitalization previously but play an important role in harm reduction for people who use drugs and are the standard of care as recommended by the CDC. A trial comparing the efficacy of immediate initiation of HCV treatment with the current standard of care among people who use drugs in Norway inspired us to consider this opportunistic test-and-treat approach to hepatitis infection for patients seen by our addiction consult service who wanted to receive ongoing care in our outpatient Bridge clinic after hospital discharge. To initiate opportunistic treatment of hepatitis C in the hospital required that medications be ordered to a specialty pharmacy and delivered to the hospital and ordered as “patient own” home medications. This was an unexpectedly necessary innovation that has required increased time coordinating care with the outpatient specialty pharmacy and the hospital pharmacy to make these medications available. Assessment of our hepatitis C treatment cascade of care is underway to address ongoing barriers to hepatitis C cure and the efficacy of this approach.

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