Eliminating the Public Health Problem of Hepatitis B and C in the United States

Buckley, Gillian J.; Strom, Brian L.

doi:10.17226/23407

Cited by 32 publications

(11 citation statements)

References 6 publications

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“…As this study determines the population-level health benefits of routine HCV testing in prisons, the implied cost burden to correctional health budgets is also uncovered. Testing and treating HCV in prisons would contribute toward the U.S. national goal of HCV elimination, 11 but doing so requires explicit public investment in correctional health budgets. Even if prices fall significantly, an expansion of the workforce including support staff will be necessary in many systems to adequately address the epidemic in a timely manner.…”

Section: Discussionmentioning

confidence: 99%

“…10 Identifying and treating HCV in correctional settings, however, could likely play an important role in the national strategy to eliminate HCV transmission. 11 Since first approved in 2013, the price of HCV DAAs has significantly decreased. 12 Even without treatment, receiving a diagnosis of HCV might lead to behavior modifications that reduce transmission, but the data are mixed.…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis C Testing and Patient Characteristics in Washington State's Prisons Between 2012 and 2016

Assoumou

Wang

Tasillo

et al. 2019

American Journal of Preventive Medicine

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Introduction: There is no widely accepted testing approach for hepatitis C virus infection in correctional settings, and many U.S. prisons do not provide routine testing. The aim of this study was to determine the most effective hepatitis C virus testing strategy in one U.S. state prison and describe the population with reactive testing. Methods: A retrospective analysis was performed using individuals entering the Washington State prison system, which routinely offers hepatitis C virus testing, to compare routine opt-out to current recommendations for risk-based and one-time testing for individuals born between 1945 and 1965. Additionally, liver fibrosis stage was characterized using aspartate aminotransferase to platelet ratio index and Fibrosis-4. Analyses were conducted in 2017. Results: Between 2012 and 2016, a total of 24,567 (83%) individuals were tested for the hepatitis C virus antibody and 4,921 (20%) were reactive (test was positive). There were 2,403 (49%) that had hepatitis C virus RNA testing with 1,727 (72%) showing chronic infection. Reactive antibody was more prevalent in individuals born between 1945 and 1965 compared with other years (44% vs 17%); however, most cases (72%) were outside of this cohort. Up to 35% of positive reactive tests would be missed with testing targeted by birth cohort and risk behavior. Of chronically infected individuals, 23% had at least moderate liver fibrosis. Conclusions: Targeted testing in the Washington State prison system missed a substantial proportion of hepatitis C virus cases; of those with reactive testing, a sizeable proportion of people had at least moderate liver disease placing them at risk for complications. Routine testing at entry should be considered by U.S. state prisons.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hepatitis C Testing and Patient Characteristics in Washington State's Prisons Between 2012 and 2016

Assoumou

Wang

Tasillo

et al. 2019

American Journal of Preventive Medicine

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“…(15) With the development of more effective curative treatments for HCV infection, progress toward the goal of eliminating hepatitis C as a public health threat by 2030 could be achieved by improving the care continuum for persons with chronic HCV infection. (16) To add to our understanding of care and treatment among underserved populations, we examined the HCV care continuum for patients engaged in care in one major urban center in the United States. We also sought to identify factors associated with successful navigation of these patients through two key steps (medical evaluation by a provider and liver disease staging) of the HCV care continuum.…”

mentioning

confidence: 99%

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

Coyle

Moorman

Bartholomew³

et al. 2019

Hepatology

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Improving care and treatment for persons infected with hepatitis C virus (HCV) can reduce HCV‐related morbidity and mortality. Our primary objective was to examine the HCV care continuum among patients receiving care at five federally qualified health centers (FQHCs) in Philadelphia, PA, where a testing and linkage to care program had been established. Among the five FQHCs, one served a homeless population, two served public housing residents, one served a majority Hispanic population, and the last, a “test and treat” site, also provided HCV treatment to patients. We analyzed data from electronic health records of patients tested for HCV antibody from 2012 to 2016 and calculated the percentage of patients across nine steps of the HCV care continuum ranging from diagnosis to cure. We further explored factors associated with successful patient navigation through two steps of the continuum using multivariable logistic regression. Of 885 chronically infected patients, 92.2% received their RNA‐positive result, 82.7% were referred to an HCV provider, 69.4% were medically evaluated by the provider, 55.3% underwent liver disease staging, 15.0% initiated treatment, 12.0% completed treatment, 8.7% were assessed for sustained virologic response (SVR), and 8.0% achieved SVR. Regression results revealed that test and treat site patients were significantly more likely to be medically evaluated (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.82‐4.17) and to undergo liver disease staging (aOR, 1.92; 95% CI, 1.02‐2.86) than patients at the other FQHCs combined. Conclusion: In this US urban setting, over two thirds of HCV‐infected patients were linked to care; although treatment uptake was low overall, it was highest at the test and treat site; scaling up treatment services in HCV testing settings will be vital to improve the HCV care continuum.

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“…Societally, the high cost of DAAs has been associated with insurer treatment restrictions and reimbursement denial, effectively rationing curative therapies (28,29,72,73). Criteria for reimbursement vary across insurers and statebased Medicaid programs, often requiring evidence of advanced liver brosis and/or abstinence from alcohol or illicit drugs (28, 74, 75), which is inconsistent with current treatment guidelines (18,27).…”

Section: Discussionmentioning

confidence: 99%

“…Curative treatment of HCV infections decreases HCV-related morbidity and mortality, liver disease progression, and end-stage complications, while prolonging survival, decreasing transmission, and improving health-related quality of life (22)(23)(24)(25)(26). However, only a minority of patients receive the health bene ts of these evidence-based therapies, with treatment uptake averaging less than 15% (18,(27)(28)(29)(30)(31)(32)(33). Multiple studies demonstrate lower rates of DAA therapy initiation among Black/African American and Hispanic/Latinx patients (34)(35)(36)(37).…”

Section: The Health Equity Implementation Frameworkmentioning

confidence: 99%

Incorporating Stigma Into Implementation Science: Linking Societal Influence to the Clinical Encounter to Understand Inequities in Healthcare Delivery

Saine

Barg

et al. 2020

Preprint

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Background: Disease-related stigma is an important, but under recognized barrier to the implementation of evidence-based therapies. Existing implementation science frameworks do not adequately specify the mechanisms by which the outer societal context produces disparate implementation outcomes. Our aim in this study was to evaluate how stigma influences the implementation of evidence-based hepatitis C virus (HCV) care and, in so doing, make the case for incorporating stigma into the Health Equity Implementation Framework.Methods: From 2015-2019, we conducted a concurrent explanatory mixed-methods study among people living with HCV in Philadelphia. We administered the validated 33-item HCV-stigma scale. Semi-structured interviews were conducted among a purposive subsample of survey respondents. Summative HCV-stigma scale scores and descriptive statistics were calculated. Interviews were transcribed and analyzed for common themes. Survey responses were linked to interview data.Results: Surveys were completed by 265 participants; 22 interviews were conducted with a subset of these respondents. Hispanic/Latinx ethnicity was associated with significantly higher HCV-stigma scale scores (adjusted mean, 81.39 [95% CI, 76.44-86.33] versus 74.28 [95% CI, 70.51-78.05]; P=0.025). In interviews, participants described the impact of stigma on their engagement with HCV care. Stigma associated with their diagnosis contributed to feelings of dirtiness and shame. Participants described the critical importance of interactions with medical providers and the healthcare system as a whole to either facilitating or mitigating the negative impact of enacted stigma on their trust in medicine and willingness to engage with HCV care. Interactions with family and friends, especially surrounding disclosure of one's diagnosis, were an important mediator of the experience of stigma. Hispanic/Latinx participants described greater feelings of isolation and stigma from family and friends as a result of their diagnosis. Finally, participants described the way stigma shaped their and society's perceptions of HCV therapies, including the media portrayal of pharmaceuticals, the high cost of drugs and insurer denials of treatment.Conclusions: Experiences of HCV-related stigma influence engagement with HCV care at multiple levels: patient, provider, family and community, and perceptions of the therapy itself. Incorporating stigma into the Health Equity Implementation Framework can improve the utility of the framework by specifying a mechanism by which the social context influences the uptake of evidence-based innovations.

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Eliminating the Public Health Problem of Hepatitis B and C in the United States

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of record. Please cite this article as

Cited by 32 publications

References 6 publications

Hepatitis C Testing and Patient Characteristics in Washington State's Prisons Between 2012 and 2016

Hepatitis C Testing and Patient Characteristics in Washington State's Prisons Between 2012 and 2016

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

Incorporating Stigma Into Implementation Science: Linking Societal Influence to the Clinical Encounter to Understand Inequities in Healthcare Delivery

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