Sa1537 HIGH SVR RATES IN 1612 PATIENTS WITH MULTIPLE COMORBID MEDICAL CONDITIONS, INCLUDING ESRD, TREATED WITH HCV DAAS IN COMMUNITY PRACTICE USING A SPECIALIZED PHARMACY TEAM

The Hepatitis C (HCV) epidemic has high morbidity and mortality, especially in high-income countries where it is primarily driven by marginalized populations, including persons who use injection drugs (PWIDs), those receiving medication assisted therapy (MAT) for opioid use disorder, those with alcohol use disorder, or those without health insurance (1-6).The advent of direct acting antivirals (DAAs) has allowed for more efficacious and curative treatments (7,8); however, sub-specialists have traditionally prescribed DAAs.These providers frequently require patients to be abstinent from drugs and alcohol for at least six months prior to initiating treatment, despite evidence and recommendations to the contrary (4-6,9,10).The aforementioned limitations to treatment access for vulnerable populations are significant barriers to achieving HCV elimination targets (4,5,9-14).We describe a lowbarrier multidisciplinary approach for treating hepatitis C in a resident primary care clinic which largely cares for marginalized inner-city populations.A team consisting of internal medicine physicians, a primary care clinical pharmacist, and an infectious disease physician created the protocol.Attending physicians and residents received education around the protocol.Primary care patients with HCV were identified.The clinical pharmacist obtained insurance authorization for the DAA medications.HCV positive patients were enrolled in the protocol, appropriately evaluated, and treated for Hepatitis C with a DAA, all directly from the primary care clinic.Currently, 33 patients are enrolled, and 30 have initiated the work-up.Twenty-nine of 30 (96.9%) have completed work-up for treatment of HCV.At the time of writing, 20/29 (68.9%) have been treated: 2 are undergoing treatment, 18 have completed treatment.There has been zero incidence of re-infection or treatment failure.Of the 33 patients enrolled, 16 (48.4%)had previously been referred to and seen by a subspecialist physician for HCV.Just one of these patients was offered treatment, others were not for a variety of reasons, including ongoing alcohol use, drug use, or uninsured status.Of those enrolled, 2 had active cocaine use, 3 are active PWID and 8 have a history of injection drug use not on MAT, 7 are on subxone, 4 are on methadone, 1 had active marijuana use, and 11 had active or recent alcohol use.Four of those treated are homeless, and 2 are uninsured.Hepatitis C can be successfully treated in an internal medicine resident primary clinic with sustained virologic response, even in marginalized populations who lack access to treatment elsewhere.Patients should not be excluded from treatment due to ongoing alcohol use, drug use, or insurance status in line with current recommendations.Primary care physicians should be educated in the methods and success of HCV treatment in a primary care setting.