Background
Direct-acting antiviral treatment regimens cure greater than 95% of chronic Hepatitis C Virus (HCV) infections, but recent studies indicate fewer than 25% of patients in United States receive treatment. Patients need to overcome barriers on the steps of the care continuum in order to be prescribed treatment. We aimed to examine the steps of the HCV care continuum up to prescription of HCV therapy among patients receiving care within a large safety-net healthcare system in Houston, Texas.
Methods
We used electronic medical records to identify patients with positive screening tests for HCV antibodies between July 1st, 2017, and June 30th, 2018, and abstracted data on their advancement through the care continuum for HCV. We used logistic regression to identify factors associated with patient navigation through the continuum.
Results
Of the 2,450 patients screening positive for HCV antibodies, 2,016 (82.3%) received quantitative RNA testing, of whom 1,081 (53.6%) exhibited chronic infection. Providers referred 915 (84.6%) to specialty care for evaluation, 540 of these patients (50.0%) received their specialist evaluation, and 299 (27.7%) received a prescription for treatment. Patients with history of substance use were less likely to be prescribed treatment (adjusted odds ratio, 0.66; 95% CI, 0.49-0.88).
Conclusions
We found substantial attrition at each stage of the HCV care continuum. In particular, history of substance abuse was a predictor of non-prescription. Challenges in the care continuum motivate increased provider education as well as the adoption of recent innovations in patient care.
AbstractA community outreach hepatitis C virus (HCV) infection screening program provided low yield of detecting HCV-infected patients, linking them to our hepatology clinic for treatment. Our data underscore that most of the yield was related to addiction centers and birth cohort; these groups should be targeted by future interventions.
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