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Barriers to hepatitis C treatment in the era of direct‐acting anti‐viral agents
Author(s) -
Lin M.,
Kramer J.,
White D.,
Cao Y.,
TavakoliTabasi S.,
Madu S.,
Smith D.,
Asch S. M.,
ElSerag H. B.,
Kanwal F.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14328
Subject(s) - medicine , hepatitis c , veterans affairs , hepatitis c virus , alcohol abuse , sofosbuvir , retrospective cohort study , ribavirin , psychiatry , immunology , virus
Summary Background Direct‐acting anti‐virals ( DAA ) are safe, effective treatment of hepatitis C virus ( HCV ). Suboptimal linkage to specialists and access to DAA s are the leading barriers to treatment; however, data are limited. Aim To determine predictors of follow‐up, receipt of DAA s, and reasons for the lack thereof. Methods We used clinical data from retrospective cohort of HCV ‐infected patients with previously established HCV care in the US Department of Veterans Affairs to examine predictors of follow‐up in HCV clinics and DAA treatment (during 12/1/2013‐4/30/2015). We then conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow‐up and treatment. Results We identified 84 221 veterans who were previously seen in HCV clinics during the pre‐ DAA era. Of these, 47 165 (56.0%) followed‐up in HCV specialty clinics, 13 532 (28.7%) of whom received DAA s. Older age, prior treatment, presence of cirrhosis or HCC , HIV / HBV co‐infection and psychiatric illness were predictors of follow‐up. Alcohol/drug abuse and medical co‐morbidity were predictors of lack of treatment. Of the 905 prospectively recruited patients, 56.2% patients had a specialist visit and 28% received DAA s. Common reasons for lack of follow‐up were relocation (n = 148, 37.4%) and missed/cancelled appointments (n = 63, 15.9%). Reasons for lack of treatment included waiting for newer therapy (n = 99, 38.8%), co‐morbidities (n = 66, 25.9%) and alcohol/drug abuse (n = 63, 24.7%). Conclusions Half of patients with established HCV care were followed‐up in the DAA era and only 29% received DAA s. Targeted efforts focusing on patient and system‐levels may improve the reach of treatment with the new DAA s.