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Hepatitis C in an urban cohort: who's not being treated?
David Alfandre1, Donald Gardenier, Alex Federman
1Department of Veterans Affairs, National Center for Ethics in Health Care, New York, NY 10010, USA. david.alfandre@va.gov
Insights
Hepatitis C virus (HCV) treatment initiation is low. Patients with HCV genotypes 1 and 4, and those with more medical conditions, were less likely to start treatment.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) infection is a significant public health concern in the U.S.
- While effective HCV treatments are available, low treatment initiation rates hinder disease control efforts.
- Understanding barriers to treatment initiation is crucial for improving patient outcomes.
Purpose of the Study:
- To identify clinical and sociodemographic factors associated with the failure to initiate HCV treatment among eligible patients.
- To inform targeted interventions aimed at increasing HCV treatment uptake.
Main Methods:
- Retrospective cohort study conducted in an urban academic hospital's primary care hepatitis C clinic.
- Inclusion criteria: multi-ethnic, HIV-negative, HCV-positive, and treatment-naïve patients.
- Analysis of HCV treatment initiation rates and associated variables (sociodemographic, viral, patient-related).
Main Results:
- Out of 168 treatment-eligible patients, only 41 initiated treatment.
- Multivariate analysis revealed that patients with HCV genotypes 1 and 4 were less likely to initiate treatment.
- Increased medical comorbidities were also significantly associated with lower treatment initiation rates.
Conclusions:
- HCV treatment initiation is influenced by specific viral genotypes and patient health status.
- Further research is necessary to elucidate the complex interplay of factors affecting treatment initiation.
- Intervention strategies are needed to overcome identified barriers and improve HCV treatment access.
Abstract:
Hepatitis C virus (HCV) remains widely prevalent in the U.S. Treatment has improved, but rates of treatment initiation remain low. We sought to identify clinical and sociodemographic characteristics of patients that are associated with failure to initiate treatment of HCV infection. We conducted a retrospective cohort study in our primary care hepatitis C treatment clinic, affiliated with an urban academic hospital. Our population was multi-ethnic, HIV-, HCV+, treatment naïve patients. We measured rates of HCV treatment initiation and sociodemographic, viral, and patient-related variables associated with non-initiation of treatment. The total number of treatment-eligible patients was 168, of whom 41 began treatment and 127 did not. In multivariate analysis, individuals with HCV genotypes 1 and 4 were less likely than others to initiate treatment, as were patients with more medical comorbidities. Further research is needed to understand how factors around initiation interact and how interventions can overcome them.
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