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Veterans: barriers to care - stigma, drug abuse - HCV Screening Rate 51%, HCV RNA Positivity 5.4%, 8.1% HCV Antibody Positivity vs HCV RNA in general population of 2.4%
  recent CDC CHeCS study found: cirrhosis in USA may be highly underestimated: estimated prevalence of cirrhosis of 25-28% in the CHC population at four health systems in the United States is in agreement with the previously modeled projection of 25% prevalence of cirrhosis in 2010 [http://www.natap.org/2015/HCV/090215_01.htm]
VA Extends New Hepatitis C Drugs to All Veterans in Its Health System - (08/15/16)
As many as 1 of 10 Vietnam veterans have chronic hepatitis C-a rate 5 times that of the general population-and Vietnam Veterans of America has begun holding educational sessions around the country to encourage them to get tested and seek care if necessary.....EXPANDING SCREENING..... Over the past several years, the VA shifted its focus to all veterans in the baby boom generation, in line with recommendations from the CDC (http://1.usa.gov/RsajNk).....By the end of last year, 70% of veterans born between 1945 and 1965 had been screened for hepatitis C, with 7400 new infections identified nationwide in 2015 alone.....Addressing the stigma associated with hepatitis C-which is closely associated with injection drug use and found disproportionately in people who are homeless and other marginalized populations-is an important part of these discussions......that's one of the reasons why so many of our people don't get tested, because of the stigma.”......Veterans with drug or alcohol addiction aren't automatically excluded from treatment at the VA, nor is there any specified abstinence requirement. But they won't be offered antiviral therapy if adherence problems are suspected..... The VA has extensive experience in treating veterans with HIV infection who also struggle with substance abuse, and the agency understands the need to address social and psychological issues that can complicate medical treatment, he noted.
VA estimates 107,000 vets have undiagnosed or untreated hepatitis C.... - (09/07/16)
Disparities in hepatitis C testing in U.S. veterans born 1945-1965.....(51%) had HCV testing with 8.1% HCV antibody and 5.4% RNA positive. - (08/15/16)
This study reports a significantly lower HCV testing rate (51%) and HCV RNA positivity (5.4%). Our HCV RNA positivity rate remains higher than birth cohort estimates for the U.S. general population of 2.4%
Of 6,669,388 birth cohort veterans, 4,221,135 (63%) received care within the VA from 2000-2013 with two or more visits. Of this group, 2,139,935 (51%) had HCV testing with 8.1% HCV antibody and 5.4% RNA positive
Of note, restriction of our analysis to individuals without identifiable risk factors for HCV reveals a lower testing rate (39%) with HCV antibody prevalence of 2.8% and HCV RNA positivity (0.9%), more akin to the broader U.S. population
At least 2.4-4.4% of veterans had scores suggesting advanced fibrosis (APRI ≥1.5 or FIB-4 >3.25) with >30-43% having positive HCV RNA but >16-20% yet to undergo testing for HCV.
Significant variation in testing was observed across centers (range: 7-83%). Older, male, African-Americans, with established risk factors and receiving care from urban centers of excellence were more likely to be tested. Among veterans free of other established risk factors (HIV negative, HBV negative, ALT ≤40 U/L, FIB-4 ≤1.45, or APRI <0.5), HCV antibody and RNA were positive in 2.8% and 0.9%, respectively, comparable to established national average.
We identified significant variability in HCV testing across VA centers (7-83%) and regional VISNs (36-66%) despite national directives, and signal the potential need for region or center-specific approaches to promote testing.

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