TY - JOUR
T1 - Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic
AU - Malespin, Miguel
AU - Harris, Ciel
AU - Kanar, Ozdemir
AU - Jackman, Kelly
AU - Smotherman, Carmen
AU - Johnston, Abbey
AU - Ferm, Julie
AU - de Melo, Silvio W.
AU - Scolapio, James S.
AU - Nelson, David R.
AU - Cotler, Scott J.
N1 - Funding Information:
Miguel Malespin: Receives research/grant support from AbbVie, Gilead, and Intercept Novo Nordisk research/grant support Ciel Harris: no conflict of interest Ozdemir Kanar: no conflict of interest Kelly Jackman: no conflict of interest Carmen Smotherman: no conflict of interest Abbey Johnston: no conflict of interest Julie Ferm: no conflict of interest Silvio W. de Melo Jr: no conflict of interest James S. Scolapio: no conflict of interest David R. Nelson: receives research/grant support from AbbVie, BMS, Gilead, and Merck Scott J. Cotler: no conflict of interest There was no financial support provided for this study.
Publisher Copyright:
© 2019 Fundación Clínica Médica Sur, A.C.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Introduction and aim: Direct-acting antiviral (DAA) agents are highly effective for treatment of chronic hepatitis C virus (HCV) yet access to treatment remains a serious challenge. The aim of this study was to identify barriers to treatment initiation with DAA-containing regimens in an urban clinic setting. Materials and methods: A retrospective cohort of all chronic HCV patients seen in an urban academic practice in Jacksonville, FL, USA from 1/2014 to 1/2017 was analyzed. Baseline characteristics were recorded and a review of medical records was performed to identify barriers to treatment initiation and overall success rates. Results: Two-hundred and forty patients with chronic HCV were analyzed. Fifty-six percent of patients were African-American and 63% were insured through Medicaid/county programs or uninsured. Sixty-nine percent had barriers to initiating antiviral therapy categorized as psychosocial (n = 112), provider (n = 26), medical (n = 20), and insurance-related factors (n = 7). The most commonly encountered psychosocial barriers included failure to keep appointments (79/240, 33%), active substance abuse (18/240, 8%), and failure to obtain laboratory testing (11/240, 5%). Overall, only 27% of patients evaluated were initiated on DAA-containing regimens with 18% reaching SVR12 within the 36-month study period. Conclusion: In conclusion, only 27% of patients who presented to an urban academic practice with chronic HCV received DAA-containing regimens over a 36-month period. Psychosocial issues were the major barriers to antiviral therapy. These findings illustrate the need for an integrated approach that addresses psychosocial factors as well as comorbidities and adherence to care in order to increase rates of HCV treatment in at risk patients.
AB - Introduction and aim: Direct-acting antiviral (DAA) agents are highly effective for treatment of chronic hepatitis C virus (HCV) yet access to treatment remains a serious challenge. The aim of this study was to identify barriers to treatment initiation with DAA-containing regimens in an urban clinic setting. Materials and methods: A retrospective cohort of all chronic HCV patients seen in an urban academic practice in Jacksonville, FL, USA from 1/2014 to 1/2017 was analyzed. Baseline characteristics were recorded and a review of medical records was performed to identify barriers to treatment initiation and overall success rates. Results: Two-hundred and forty patients with chronic HCV were analyzed. Fifty-six percent of patients were African-American and 63% were insured through Medicaid/county programs or uninsured. Sixty-nine percent had barriers to initiating antiviral therapy categorized as psychosocial (n = 112), provider (n = 26), medical (n = 20), and insurance-related factors (n = 7). The most commonly encountered psychosocial barriers included failure to keep appointments (79/240, 33%), active substance abuse (18/240, 8%), and failure to obtain laboratory testing (11/240, 5%). Overall, only 27% of patients evaluated were initiated on DAA-containing regimens with 18% reaching SVR12 within the 36-month study period. Conclusion: In conclusion, only 27% of patients who presented to an urban academic practice with chronic HCV received DAA-containing regimens over a 36-month period. Psychosocial issues were the major barriers to antiviral therapy. These findings illustrate the need for an integrated approach that addresses psychosocial factors as well as comorbidities and adherence to care in order to increase rates of HCV treatment in at risk patients.
KW - Barriers to treatment
KW - Chronic hepatitis C
KW - Direct acting antivirals
KW - Psychosocial factors
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U2 - 10.1016/j.aohep.2018.06.001
DO - 10.1016/j.aohep.2018.06.001
M3 - Article
C2 - 31053544
AN - SCOPUS:85066163894
SN - 1665-2681
VL - 18
SP - 304
EP - 309
JO - Annals of Hepatology
JF - Annals of Hepatology
IS - 2
ER -