Short article: Alcohol and substance use, race, and insurance status predict nontreatment for hepatitis C virus in the era of direct acting antivirals: a retrospective study in a large urban tertiary center

Sims, Omar T.; Guo, Yuqi; Shoreibah, Mohamed; Venkata, Krishna; Fitzmorris, Paul; Kommineni, Vishnu; Romano, John; Massoud, Omar

doi:10.1097/meg.0000000000000961

Cited by 21 publications

(13 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Men had lower SVR rates, consistent with prior studies [ 24 , 25 ]. Disparities are often seen related to treatment outcomes of racial minorities [ 26 , 27 ]; however, we did not see an impact of race on SVR. Additionally, young age, generally considered to be less than 30 years, has been associated with both higher [ 25 , 28 ] and lower [ 29 ] rates of linkage to care but was not associated with outcomes in our cohort.…”

Section: Discussioncontrasting

confidence: 84%

Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services

Sherbuk

McManus

McQuade

et al. 2018

Open Forum Infectious Diseases

View full text Add to dashboard Cite

BackgroundHepatitis C is now curable for most individuals, and national goals for elimination have been established. Transmission persists, however, particularly in nonurban regions affected by the opioid epidemic. To reach goals of elimination, barriers to treatment must be identified.MethodsIn this open cohort of all individuals diagnosed with active hepatitis C from 2010 to 2016 at a large medical center, 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 misuse.ResultsSVR was achieved in 1544 (41%) of 3790 people with active hepatitis C. In a multivariable Poisson regression model, SVR was more likely in individuals diagnosed outpatient (incident rate ratio [IRR], 1.7; 95% confidence interval [CI], 1.5–2.0), living in close proximity to the medical center (IRR, 1.2; 95% CI, 1.1–1.3), with private insurance (IRR, 1.1; 95% CI, 1.0–1.3), and with cirrhosis (IRR, 1.4; 95% CI, 1.3–1.5). Achieving SVR was less likely in those qualifying as indigent (IRR, 0.8; 95% CI, 0.8–0.9) and those with substance misuse (IRR, 0.8; 95% CI, 0.7–0.9). In the subgroup analysis of those with substance misuse, SVR rates were higher in those linked to the infectious diseases clinic, which has embedded support services, than those linked to the gastroenterology clinic, which does not (IRR, 1.4; 95% CI, 1.1–1.9).ConclusionsSocial determinants of health including proximity to care and poverty impacted achievement of SVR. Those with substance misuse, a high-priority population for treatment of hepatitis C, had better outcomes when receiving care in a clinic with embedded support services.

show abstract

Section: Discussioncontrasting

confidence: 84%

Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services

Sherbuk

McManus

McQuade

et al. 2018

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Another possibility is that patients whose disease evolved to a more advanced stage in the interim years had a high mortality rate and were subsequently not represented in Epoch 2. This latter possibility, when viewed together with the finding that a significant proportion of Epoch 2 patients qualified for shorter 8 week DAA treatment regimens, would significantly strengthen the argument for the cost-effectiveness of augmenting access to HCV screening and treatment, particularly in historically underserved AA populations [8,14,15] .…”

Section: Discussionmentioning

confidence: 90%

“…The ethnic makeup of this study is notable as AA patients are more prone to have failed earlier interferon based therapy [8,9] . Further, AA patient populations have historically had decreased access to care and a comparatively lower likelihood for treatment when care is established [14] .…”

Section: Discussionmentioning

confidence: 99%

Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

Rutledge

Mahajan

Naylor

et al. 2017

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

INTRODUCTION: There is considerable uncertainty with respect to predicting the liver disease status of African American (AA) patients with Hepatitis C seen in the current era of highly effective direct acting anti-virals (DAA). This uncertainty is due to the complex interplay between the identification of patients early in their disease progression by screening, the fact that many AA patients failed earlier interferon based therapy, duration of the HCV viremia in AA patients, the possible variation In disease course in AA as compared to other races, and potential early mortality of AA patients due to liver disease. Understanding the evolution of HCV infection as defined by comparing previous and current patient populations provides information relevant to both therapeutic and health costs decisions. METHODS: We selected patients from a 24 month period between 2002 and 2003 (Epoch 1; n = 414) to compare with patients seen in the same GI clinic between 2012 and 2013 (Epoch 2; n=405). Epoch 1 was the beginning of the peg-interferon and ribavirin treatment era and Epoch 2 reflects the patient population seen when DAA therapy was first available. RESULTS: Epoch 2 patients were older (59.7 vs 50.3 years) with a similar gender distribution (55% vs 59% male). Consistent with the change in clinic demographics, more AA patients were seen in Epoch 2 (89%) as compared to Epoch 1 (77%). There was no significant difference between hepatic fibrosis as assessed by APRI (1.1 vs 0.9) or FIB-4 (2.4 vs 2.6) but there was an increase in intermediate degree of fibrosis as defined by liver biopsy. The majority of Epoch 2 patients were still naïve to treatment (96% Epoch 1 vs 61% Epoch 2) and a similar proportion had cirrhosis (15% Epoch 1 vs 17% Epoch 2) at the time of first visit in the different time periods. CONCLUSIONS: The patients in Epoch 2 from this urban GI referral clinic are older and the majority of them had not been treated or had not responded to treatment. This age demographic continues to reflect patients who were likely infected during the 1960's-1980's which is when HCV infection became widespread. Epoch 2 patients also do not have more advanced liver disease as defined either by significant fibrosis or cirrhosis as compared to Epoch 1. Possible explanations include that Epoch 2 patients' disease was detected earlier by surveillance, progressed very slowly to advanced liver disease, or had a high mortality that resulted in a decline in patients with advanced disease. The role of access to therapy in patients not treated remains to be determined and the increased effectiveness of DAA are predicted to increase the number of AA patients seeking and accepting treatment.

show abstract

“…Unfortunately, new DAA regimens can cost more than $5000 per week for the duration of treatment that can be as long as 24 weeks [ 24 ]. Lack of insurance is associated with a decreased likelihood of being offered or receiving treatment for HCV infection [ 25 ]. Low treatment uptake, defined as initiating treatment after being prescribed DAAs, also remains a barrier to treating HCV effectively [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Obstacles to successful treatment of hepatitis C in uninsured patients from a minority population

et al. 2018

View full text Add to dashboard Cite

BackgroundHepatitis C virus (HCV) treatment regimens (DAAs) are well tolerated, efficacious but costly. Their high cost and restricted availability, raises concerns about the outcome of treatment in uninsured patients. This study investigated sustained virologic response (SVR) outcomes in a predominately uninsured patient population and completion of four steps along the HCV treatment cascade.MethodsA retrospective chart review was conducted to characterize the patient population and analyze covariates to determine association with insurance status, attainment of SVR and progression through the HCV treatment cascade.ResultsOut of a total of 216 patients, 154 (71%) were uninsured. Approximately 50% of patients (109 of 216 patients) were male and 57% were Hispanic (123 of 216 patients). Sex, race, ethnicity, treatment compliance, and rates of complications were not associated with insurance status. Insured patients were older (median 60 years vs 57 years, p-value < 0.001) and had higher rates of cirrhosis: 32 out of 62 patients (52%) vs 48 out of 154 patients (31%) (p-value = 0.005). Insured patients were tested for SVR at similar rates as uninsured patients: 84% (52 of 62 patients) vs 81% (125 of 154 patients), respectively. Of those tested for SVR, the cure rate for insured patients was 98% (51 out of 52 patients) compared to 97% (121 out of 125 patients) in the uninsured. Out of those who completed treatment, 177 of 189 (94%) were tested for attainment of SVR. Compliance rates were significantly different between tested and untested patients: 88% (156 of 177 patients) vs 0% (0 of 12 patients), respectively (p-value < 0.001). However, insurance status, race ethnicity, cirrhosis, and complications were not associated with being tested for SVR.ConclusionsThese results demonstrate that insured and uninsured patients with chronic HCV infection, with access to patient assistance programs, can be treated and have comparable clinical outcomes. In addition, testing for SVR remains an important obstacle in completion of the HCV treatment cascade. Nevertheless, patient assistance programs remove a significant barrier for treatment access in real-world HCV infected populations.Electronic supplementary materialThe online version of this article (10.1186/s12967-018-1555-y) contains supplementary material, which is available to authorized users.

show abstract

Short article: Alcohol and substance use, race, and insurance status predict nontreatment for hepatitis C virus in the era of direct acting antivirals: a retrospective study in a large urban tertiary center

Cited by 21 publications

References 32 publications

Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services

Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services

Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

Obstacles to successful treatment of hepatitis C in uninsured patients from a minority population

Contact Info

Product

Resources

About