2206. In a Non-urban Hepatitis C Cohort, Linkage to an Infectious Diseases Clinic with Embedded Services Is Associated with Better Outcomes Than Linkage to a Gastroenterology HCV Clinic Without These Services for Those with Substance Abuse

BACKGROUND: Hepatitis C virus (HCV) infection is now curable for most individuals and national goals for elimination have been established. Transmission remains ongoing, particularly in non-urban regions affected by the opioid epidemic. To reach elimination goals, barriers to treatment must be identified with a priority placed on those with substance abuse. METHODS: In this retrospective cohort study of all individuals with chronic HCV from 2010 to 2016 at a large medical center serving a predominately non-urban population, we identified patient and clinic characteristics associated with our primary outcome, sustained virologic response (SVR). We performed a subgroup analysis for those with documented substance abuse. RESULTS: SVR was achieved in 1,544 (41%) of 3,790 people with chronic HCV (Figure 1). In a multivariate Poisson regression model adjusted for patient demographics and year of diagnosis, SVR was less likely in those with substance abuse (IRR 0.8, 95% CI 0.7–0.9). In the subgroup analysis of those with substance abuse (N = 682), SVR rates were higher in those linked to the infectious diseases clinic, which has embedded support services, than in those linked to gastroenterology, which does not (IRR 1.4, 95% CI 1.1–1.9) (table). Higher SVR rates were driven by an increased rate of medication prescribing in those linked to infectious diseases (IRR 1.3, 95% CI 1.1–1.6) (Figure 2). CONCLUSION: Those with substance abuse, a high priority population for treatment of HCV, had better outcomes when receiving care in a clinic with embedded support services. DISCLOSURES: All authors: No reported disclosures.