title: Utility of evaluating HCV in an uninsured population.
abstract: OBJECTIVE
  Although effective HCV treatment is available, it can be difficult to access for uninsured, urban patients. Our aim was to assess the utility of evaluation and outcomes in the uninsured with HCV when access to health care and treatment with triple therapy is provided.
  
  
  METHODS
  We performed a retrospective review of consecutive patients referred for HCV from 2011 to June 2013 to an indigent HCV clinic. The primary outcomes were assessment of disease severity by noninvasive means and initiation of therapy.
  
  
  RESULTS
  We identified 350 patients: mean age 50.6, 84 % with no insurance, 62 % men, 58 % black, 91 % HCV treatment naïve. Of these, 148 underwent liver biopsy and 68 % had F0-F1 and 10 % had F3-F4 fibrosis. FIB-4 and APRI were highly correlated (r = 0.9; p < .0001) and correctly classified patients by fibrosis strata (F0-F1, F2, and F3-F4; p = .0004). When combined, a FIB-4 ≤1.5 and APRI ≤0.5 correctly classified the absence of advanced disease in 97 % (p < .0001). Of those evaluated, 39 (11 %) went on to HCV treatment. Of those not in a clinical trial, 51 % completed treatment with SVR in 61 % with genotype 1 and 75 % in genotypenon-1. Of those not treated (n = 309), the most common reasons were mild disease (16 %), lost to follow-up (23 %), ongoing alcohol or substance abuse (24 %), and uncontrolled depression (10 %).
  
  
  CONCLUSIONS
  Noninvasive assessment can accurately exclude advanced fibrosis. Despite access to care, the utility of evaluating to initiate HCV treatment is low suggesting that eliminating the barrier to health care may not increase HCV treatment.
authors.affiliation: Section of Hepatology, Virginia Commonwealth University, 1200 E Broad St, West Hospital, Rm 1478, PO Box 980341, Richmond, VA, 23298-0341, USA.
authors.forename: Indira
authors.initials: I
authors.lastname: Donepudi
authors.forename: Angelo
authors.initials: A
authors.lastname: Paredes
authors.forename: Sarah
authors.initials: S
authors.lastname: Hubbard
authors.forename: Chadi
authors.initials: C
authors.lastname: Awad
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008489:Medical Indigency; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D000998:Antiviral Agents