Race and Hepatitis C Care Continuum in an Underserved Birth Cohort
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Published on: January 12, 2018
Nicole J Kim1,2, Cameron J Locke1,2, Helen Park1,2
1Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Insights
Hepatitis C virus (HCV) screening reached nearly all patients, but confirmation and treatment gaps persist, varying by race. Targeted interventions are crucial for diverse, underserved populations to improve HCV care continuum outcomes.
Area of Science:
- Hepatology and Gastroenterology
- Public Health
- Epidemiology
Background:
- Birth cohort screening for hepatitis C virus (HCV) is recommended, particularly for underserved populations who experience disproportionately higher HCV burdens.
- Limited understanding exists regarding the impact of race on the HCV care continuum within these vulnerable groups.
Purpose of the Study:
- To evaluate the hepatitis C virus (HCV) care cascade within a large, racially diverse, and underserved patient population born between 1945 and 1965.
Main Methods:
- A retrospective cohort study analyzed electronic medical records of 34,810 patients from San Francisco Health Network safety-net clinics.
- Data collection spanned from October 1, 2014, to August 31, 2017, focusing on HCV testing, treatment initiation, and treatment response.
Main Results:
- While HCV testing was nearly universal (99.7%), significant gaps were observed in confirmatory HCV RNA testing (22.9% of antibody-positive patients) and treatment initiation (20.8% of viremic patients).
- Asian/Pacific Islanders (APIs) showed the highest screening and treatment rates, whereas Black patients had the highest chronic HCV prevalence. Latino patients exhibited the lowest sustained virologic response (SVR) rates.
- Multivariable analysis identified API race, HIV co-infection, and non-English preferred language as associated with higher HCV treatment rates, while chronic kidney disease and higher ALT levels were associated with lower treatment rates.
Conclusions:
- Despite high screening rates, critical gaps in HCV confirmation, treatment, and cure verification exist, influenced by racial disparities.
- Developing tailored interventions is essential to effectively engage and treat diverse, underserved populations to improve outcomes across the HCV care continuum.
Background:
Birth cohort screening is recommended for hepatitis C virus (HCV) and underserved populations are disproportionally affected by HCV. Little is known about the influence of race on the HCV care continuum in this population.
Objective:
To assess the cascade of HCV care in a large racially diverse and underserved birth cohort.
Design:
Retrospective cohort study using electronic medical record data abstracted until August 31, 2017.
Patients:
34,810 patients born between 1945 and 1965 engaged in primary care between October 1, 2014, and October 31, 2016, within the safety-net clinics of the San Francisco Health Network.
Main Measures:
Rate of hepatitis C testing, hepatitis C treatment, and response to therapy.
Results:
Cohort characteristics were as follows: median age 59 years, 57.6% male, 25.5% White (20.6% Black, 17.7% Latino, 33.0% Asian/Pacific Islander (API), 2% other), and 32.6% preferred a non-English language. 99.7% had an HCV test (95.4% HCV antibody, 4.3% HCVRNA alone). Among HCV antibody-positive patients (N = 4587), 22.9% were not tested for confirmatory HCVRNA. Among viremic patients (N = 3673), 20.8% initiated HCV therapy, 90.6% achieved sustained virologic response (SVR) and 8.1% did not have a SVR test. HCV screening and treatment were highest in APIs (98.7 and 34.7% respectively; p < 0.001). Blacks had the highest chronic HCV rate (22.2%; p < 0.001). Latinos had the lowest SVR rate (81.3%; p = 0.01). On multivariable analysis, API race (vs White, OR 1.20; p = 0.001), presence of HIV co-infection (OR 1.58; p = 0.02), presence of chronic kidney disease (OR 0.47; p < 0.001), English (vs non-English) as preferred language (OR 0.54; p = 0.002), ALT (OR 0.39 per doubling; p < 0.001), and HCVRNA (OR 0.83 per 10-fold increase; p < 0.001) were associated with HCV treatment.
Conclusions:
Despite near-universal screening, gaps in active HCV confirmation, treatment, and verification of cure were identified and influenced by race. Tailored interventions to engage and treat diverse and underserved populations with HCV infection are needed.
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