title: The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis.
abstract: BACKGROUND
  Identifying gaps in care for people with chronic hepatitis C virus (HCV) infection is important to clinicians, public health officials, and federal agencies. The objective of this study was to systematically review the literature to provide estimates of the proportion of chronic HCV-infected persons in the United States (U.S.) completing each step along a proposed HCV treatment cascade: (1) infected with chronic HCV; (2) diagnosed and aware of their infection; (3) with access to outpatient care; (4) HCV RNA confirmed; (5) liver fibrosis staged by biopsy; (6) prescribed HCV treatment; and (7) achieved sustained virologic response (SVR).
  
  
  METHODS
  We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews for articles published between January 2003 and July 2013. Two reviewers independently identified articles addressing each step in the cascade. Studies were excluded if they focused on specific populations, did not present original data, involved only a single site, were conducted outside of the U.S., or only included data collected prior to 2000.
  
  
  RESULTS
  9,581 articles were identified, 117 were retrieved for full text review, and 10 were included. Overall, 3.5 million people were estimated to have chronic HCV in the U.S. Fifty percent (95% CI 43-57%) were diagnosed and aware of their infection, 43% (CI 40-47%) had access to outpatient care, 27% (CI 27-28%) had HCV RNA confirmed, 17% (CI 16-17%) underwent liver fibrosis staging, 16% (CI 15-16%) were prescribed treatment, and 9% (CI 9-10%) achieved SVR.
  
  
  CONCLUSIONS
  Continued efforts are needed to improve HCV care in the U.S. The proposed HCV treatment cascade provides a framework for evaluating the delivery of HCV care over time and within subgroups, and will be useful in monitoring the impact of new screening efforts and advances in antiviral therapy.
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York, United States of America.
authors.forename: Asher J
authors.initials: AJ
authors.lastname: Schranz
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America; Center for Evidenced-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States of America.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
mesh_terms: D000553:Ambulatory Care; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
chemical_list: D012367:RNA, Viral