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International Journal of Hepatology
Volume 2017, Article ID 5834182, 8 pages
Clinical Study

HCV Integrated Care: A Randomized Trial to Increase Treatment Initiation and SVR with Direct Acting Antivirals

1VA San Diego Healthcare System, San Diego, CA, USA
2University of California, San Diego, San Diego, CA, USA

Correspondence should be addressed to Erik J. Groessl; ude.dscu@lsseorge

Received 15 April 2017; Revised 10 June 2017; Accepted 12 June 2017; Published 27 July 2017

Academic Editor: Maria Buti

Copyright © 2017 Erik J. Groessl et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background and Aims. Psychiatric or substance use disorders are barriers to successful HCV antiviral treatment. In a randomized, controlled trial (RCT), the effects of HCV Integrated Care (IC) for increasing treatment rates and sustained viral response (SVR) were studied with direct acting antivirals (DAA). Methods. In 2012-13, VA patients, whose screening was positive for depression, PTSD, or substance use (), were randomized to IC or Usual Care (UC). IC consisted of brief psychological interventions and case management. The primary endpoint was SVR among patients followed for an average of 16.6 months. Results. 42% of the study participants were previously homeless and 79% had HCV genotype 1. Twice as many IC participants (45%) initiated treatment compared with UC participants (23%) ( = 4.59, ). Among those treated, SVR rates did not significantly differ (IC: 12/18 = 67%; UC: 5/9 = 55%; ). Among all randomized participants, IC participants trended toward better SVR rates (30.0% versus 12.8% in UC; ). Conclusions. Although first-generation DAAs are no longer used, this smaller RCT helps confirm the results of a larger multisite RCT showing that Integrated Care results in higher treatment initiation and SVR rates among HCV-infected persons with comorbid psychological disorders. Integrated mental health services can facilitate treatment among the most challenging HCV patients, many of whom have not been successfully treated. This trial is registered with number NCT00722423.