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Updated: May 11, 2025
A Protocol for Analyzing Hepatitis C Virus Replication
Published on: June 26, 2014
Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States
Megan Rose Curtis1, Sarah Munroe2, Breanne E Biondi3
1Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Insights
Pediatric Hepatitis C (HCV) care access is low in the US. Few children with HCV link to care or receive direct-acting antiviral (DAA) treatment, revealing significant racial disparities.
Area of Science:
- Pediatric infectious diseases
- Public health
- Hepatology
Background:
- Pediatric Hepatitis C Virus (HCV) cases are rising in the US.
- Current guidelines recommend early treatment for children as young as 3 years old.
- National data on pediatric HCV care linkage and direct-acting antiviral (DAA) uptake are lacking.
Purpose of the Study:
- To characterize the HCV care cascade among a national cohort of children diagnosed with HCV.
- To evaluate national-level pediatric linkage to HCV care and DAA uptake.
- To identify racial and ethnic disparities in pediatric HCV care access.
Main Methods:
- Retrospective cohort analysis of children born between 2000-2018 diagnosed with HCV (ages 0-18).
- Utilized the TriNetX Research Network, a US national electronic health records database.
- Assessed HCV diagnosis, linkage to care, and DAA prescription rates, with logistic regression for race/ethnicity and care linkage.
Main Results:
- Out of 928 children with HCV, 32.0% linked to care and 12.0% received DAAs.
- Hispanic/Latinx children had double the odds of linkage compared to Black children (OR, 2.20).
- White children had triple the odds of linkage compared to Black children (OR, 3.44), adjusted for covariates.
Conclusions:
- Pediatric access to HCV care is critically low, with less than one-third linking to care and fewer than one-eighth treated.
- Significant racial and ethnic disparities exist in accessing HCV care.
- Interventions focused on improving care linkage are crucial for HCV elimination and reducing health inequities.
Background And Objectives:
Pediatric HCV cases have increased in the United States. Guidelines recommend beginning treatment of HCV for children as young as 3 years old. However, no studies have evaluated pediatric linkage to HCV care and direct-acting antiviral (DAA) uptake on a national level. This study aims to characterize the HCV care cascade among a national cohort of children with HCV.
Methods:
This retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. We analyzed TriNetX Research Network data, a US national electronic health records network. Primary HCV care cascade outcomes included the number of children diagnosed with HCV infection, linked to care, and prescribed DAAs. We assessed the association between race and ethnicity with linkage to care using logistic regression.
Results:
Among 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA. Hispanic/Latinx children had double and white children had triple the odds of linkage compared with Black children (odds ratio [OR], 2.20; 95% CI, 1.05-4.59; OR, 3.44; 95% CI, 1.89-6.28) after adjusting for sex, birth cohort, and region.
Conclusions:
Pediatric access to HCV care remains low. Fewer than 1 in 3 children linked to HCV care and fewer than 1 in 8 were treated. This study uncovers racial and ethnic disparities in HCV care access. Targeting interventions toward increasing linkage to care could represent an opportunity to advance HCV elimination goals and reduce disparities.
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