Hepatitis C Direct Acting Antiviral Therapies in a New York City HIV/AIDS Special Needs Plan: Uptake and Barriers

Kuniholm, Mark H.; Leach, Terry; Lunievicz, Joseph; Olivo, Noemí; Anastos, Kathryn; Vazquez, Yvette; Brennan-Ing, Mark; Karpiak, Stephen E.; Alao, Oladipo A.; Nash, Denis; Ernst, J. A.

doi:10.1089/apc.2015.0240

Cited by 4 publications

(7 citation statements)

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“…24 In 2 separate studies evaluating much smaller cohorts of HIV/HCV coinfected patients, DAA treatment uptake was 14% and 6% over time periods similar to the VA report. 29,30…”

Section: Discussionmentioning

confidence: 99%

Uptake of and Factors Associated With Direct-acting Antiviral Therapy Among Patients in the Chronic Hepatitis Cohort Study, 2014 to 2015

Spradling

Xing

Rupp

et al. 2018

Journal of Clinical Gastroenterology

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“…24 In 2 separate studies evaluating much smaller cohorts of HIV/HCV coinfected patients, DAA treatment uptake was 14% and 6% over time periods similar to the VA report. 29,30…”

Section: Discussionmentioning

confidence: 99%

Uptake of and Factors Associated With Direct-acting Antiviral Therapy Among Patients in the Chronic Hepatitis Cohort Study, 2014 to 2015

Spradling

Xing

Rupp

et al. 2018

Journal of Clinical Gastroenterology

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“…These organizational constraints (e.g., prior authorizations) may themselves pose barriers to medical evaluation completion and care continuum progress (40, 52, 53). Similarly, providers, in response to guidelines or unconscious biases, differentially apply “eligibility criteria” in ways that constituting a “stutter-step” in health-care provision, and introducing health disparities (25, 51).…”

Section: Resultsmentioning

confidence: 99%

“…For example, the HIV continuum does not convey the fact that many people are diagnosed late in the course of their infection (52). It also does not convey the timeliness of linkages to care or of achieving viral suppression.…”

Section: Resultsmentioning

confidence: 99%

“…In that sense, achieving certain steps of HIV prevention and care might appropriately be construed as part of a HCV continuum model. Similarly, care systems for HCV may require screening for and treatment of SUDs (52). As an example of interacting care continua, for persons with HIV-related TB, the fact that TB treatment should precede ART initiation, and that in analyses the need for TB treatment is associated with late ART initiation, demonstrates that progress through these two care continua are linked (66).…”

Section: Resultsmentioning

confidence: 99%

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Conceptualizing Care Continua: Lessons from HIV, Hepatitis C Virus, Tuberculosis and Implications for the Development of Improved Care and Prevention Continua

Perlman

Jordan

Nash

2017

Front. Public Health

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BackgroundTo examine the application of continuum models to tuberculosis, HIV, and other conditions; to theorize the concept of continua; and to learn lessons that could inform the development of improved care and prevention continua as public health metrics.MethodsAn analytic review of literature drawn from several fields of health care.ResultsThe continuum construct is now part of public health evaluation systems for HIV, and is increasingly used in public health and the medical literature. Issues with the comparability and optimal design of care continuum models have been raised, and their methodologic and theoretic underpinnings and scope of focus have been under-addressed. Review of relevant publications suggests that a key limitation of current models is their lack of measures reflecting incidence and mortality. Issues relating to continua data being longitudinal or cross-sectional, definition of numerators and denominators for each step, data sources, measures of timeliness of step completion, theoretic models to facilitate inferences of causes of care continuum gaps, how measures of prevention efforts, reinfection/relapses, and interactions of continua for co-occurring comorbidities should be reflected, and how analyses of differences in retention over time, across geographic regions, and in response to interventions should be conducted are critical to the development of sound care and prevention continuum models.ConclusionLessons learned from the application of continuum models to HIV and other conditions suggest that the application of well-formulated constructs of care and prevention continua, that depict, in well defined, standardized steps, incidence and mortality, along with degrees of and time to screening, engagement in care and prevention, treatment and treatment outcomes, including relapse or reinfection, may be vital tools in evaluating intervention and program outcomes, and in improving population health and population health metrics for a wide range conditions.

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“…This may be indicative of a provider-level and/or systematic bias relating to medication adherence, AIDS status, and HIV-1 RNA viral load; providers may have been limiting care to “ideal patients” as determined by payers and government agencies. 24,25 In addition, health beliefs, stigma and medication, and appointment adherence have been shown to be strongly associated with engagement in HCV care. 26–28 However, these barriers were often seen before the era of DAA medications.…”

Section: Discussionmentioning

confidence: 99%

HCV Screening and Treatment Uptake Among Patients in HIV Care During 2014–2015

Radwan

Falade‐Nwulia

Moore

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Despite the high prevalence of hepatitis C virus (HCV) among persons living with HIV (PWH), the prevalence of HCV screening, treatment, and sustained virologic response (SVR) is unknown. This study aims to characterize the continuum of HCV screening and treatment among PWH in HIV care. Setting: Adult patients enrolled at 12 sites of the HIV Research Network located in 3 regions of the United States were included. Methods: We examined the prevalence of HCV screening, HCV coinfection, direct-acting antiretroviral (DAA) treatment, and SVR-12 between 2014 and 2015. Multivariate logistic regression was performed to identify characteristics associated with outcomes, adjusted for site. Results: Among 29,071 PWH (age 18–87, 74.8% male, 44.4% black), 77.9% were screened for HCV antibodies; 94.6% of those screened had a confirmatory HCV RNA viral load test. Among those tested, 61.1% were determined to have chronic HCV. We estimate that only 23.4% of those eligible for DAA were prescribed DAA, and only 17.8% of those eligible evidenced initiating DAA treatment. Those who initiated treatment achieved SVR-12 at a rate of 95.2%. Blacks and people who inject drugs (PWID) were more likely to be screened for HCV than whites or those with heterosexual risk. Persons older than 40 years, whites, Hispanics, and PWID [adjusted odds ratio (AOR) 8.70 (7.74 to 9.78)] were more likely to be coinfected than their counterparts. When examining treatment with DAA, persons older than 50 years, on antiretroviral therapy [AOR 2.27 (1.11 to 4.64)], with HIV-1 RNA <400 [AOR 2.67 (1.71 to 4.18)], and those with higher Fib-4 scores were more likely to be treated with DAA. Conclusions: Although rates of screening for HCV among PWH are high, screening remains far from comprehensive. Rates of SVR were high, consistent with previously published literature. Additional programs to improve screening and make treatment more widely available will help reduce the impact of HCV morbidity among PWH.

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Hepatitis C Direct Acting Antiviral Therapies in a New York City HIV/AIDS Special Needs Plan: Uptake and Barriers

Cited by 4 publications

References 12 publications

Uptake of and Factors Associated With Direct-acting Antiviral Therapy Among Patients in the Chronic Hepatitis Cohort Study, 2014 to 2015

Uptake of and Factors Associated With Direct-acting Antiviral Therapy Among Patients in the Chronic Hepatitis Cohort Study, 2014 to 2015

Conceptualizing Care Continua: Lessons from HIV, Hepatitis C Virus, Tuberculosis and Implications for the Development of Improved Care and Prevention Continua

HCV Screening and Treatment Uptake Among Patients in HIV Care During 2014–2015

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