Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 304-309 |
| Number of pages | 6 |
| Journal | Annals of hepatology |
| Volume | 18 |
| Issue number | 2 |
| DOIs | |
| State | Published - Mar 1 2019 |
| Externally published | Yes |
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Keywords
- Barriers to treatment
- Chronic hepatitis C
- Direct acting antivirals
- Psychosocial factors
ASJC Scopus subject areas
- Hepatology
Cite this
Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic. / Malespin, Miguel; Harris, Ciel; Kanar, Ozdemir; Jackman, Kelly; Smotherman, Carmen; Johnston, Abbey; Ferm, Julie; del Melo, Silvio; Scolapio, James S.; Nelson, David R.; Cotler, Scott J.
In: Annals of hepatology, Vol. 18, No. 2, 01.03.2019, p. 304-309.Research output: Contribution to journal › Article
}
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 - del Melo, Silvio
AU - Scolapio, James S.
AU - Nelson, David R.
AU - Cotler, Scott J.
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
UR - http://www.scopus.com/inward/record.url?scp=85066163894&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066163894&partnerID=8YFLogxK
U2 - 10.1016/j.aohep.2018.06.001
DO - 10.1016/j.aohep.2018.06.001
M3 - Article
VL - 18
SP - 304
EP - 309
JO - Annals of Hepatology
JF - Annals of Hepatology
SN - 1665-2681
IS - 2
ER -