Excellence in Liver Care Spotlight: Veterans Health Administration
The HIV, Hepatitis, and Related Conditions Programs (HHRC) in the Veterans Health Administration (VA) is working to improve care for viral hepatitis and liver disease. The VA has seen many recent accomplishments in the treatment and cure of Veterans in VA care with hepatitis C and look to build on these successes for Veterans with hepatitis B and advanced liver disease (ALD).
Through the use of more effective medications and increased access to care for patients, we have made significant progress in curing Veterans with hepatitis C. Along with the use of new medications, VA created regional Hepatitis C Innovation Teams (HITs) that helped create promising practices to address gaps in care delivery. Through the HITs, we’ve expanded the use of non-physician providers (clinical pharmacists/nurse practitioners/physician assistants), increased outreach to engage Veterans in care, and provided supports to keep Veterans in care. Examples of innovations include liver care teams partnering with inpatient and outpatient substance use treatment clinics to provide patient education and coordinate HCV treatment, and utilizing mobile technology to enroll and link Veterans to care. VA’s success in the treatment of Veterans with hepatitis C is outlined in an Annals of Internal Medicine article and the innovations are discussed in more detail in a Federal Practitioner article. To date, VA has treated over 110,000 Veterans with the new hepatitis C medications and we are very close to marking our 100,000th Veteran cured of hepatitis C!
With this success in hepatitis C, the HITs have expanded their scope to include advanced liver disease, or cirrhosis. Over 80,000 Veterans in VA care have ALD, with 10,000-15,000 new diagnoses each year. These teams are beginning the work of bringing innovative practices to the diagnosis and treatment of cirrhosis. Teams will approach process improvement work in a step-wise manner, tailored to their local context. Our aim is to decrease unnecessary hospital admissions, improve quality of life, and reduce mortality for patients with ALD. These are challenging goals, but our teams are charting a course to more broadly expand and increase access to cirrhosis care and management.
Finally, hepatitis B is an area of focus for the VA. The prevalence of HBV infection among Veterans in VA care is slightly higher than that in the US civilian population at 0.4%. HHRC has led a National Hepatitis B Working Group with membership that represented broad, multidisciplinary expertise in HBV. This group developed general clinical guidelines for the provision of high-quality care for patients with HBV, identified areas for HBV quality improvement, and created tools to increase education and provide clinical support, which is discussed in more detail in a Federal Practitioner article. In the year ahead, we will be promoting this work and sharing materials in our efforts to improve screening, vaccination, and treatment.
To learn more about the VA’s viral hepatitis and advanced liver disease program and view resources, visit: https://www.hepatitis.va.gov/