title: Reasons for HCV non-treatment in underserved African Americans: implications for treatment with new therapeutics.
abstract: BACKGROUND
  African Americans are disproportionately affected by hepatitis C (HCV) and are less likely to undergo HCV treatment. Underserved populations are especially at risk for experiencing health disparity. Aim. To identify reasons for HCV non-treatment among underserved African Americans in a large safetynet system.
  
  
  METHODS
  Medical records of HCV-infected African Americans evaluated at San Francisco General Hospital liver specialty clinic from 2006-2011 who did not receive HCV treatment were reviewed. Treatment eligibility and reasons for non-treatment were assessed. Factors associated with treatment ineligibility were assessed using logistic regression modeling.
  
  
  RESULTS
  Among 118 patients, 42% were treatment ineligible, 18% treatment eligible, and 40% were undergoing work-up to determine eligibility. Reasons for treatment ineligibility were medical (54%), non-medical (14%), psychiatric (4%), or combined (28%). When controlling for age and sex, active/recent substance abuse (OR 6.65, p = 0.001) and having two or more medical comorbidities (OR 3.39, p = 0.005) predicted treatment ineligibility. Excluding those ineligible for treatment, 72% of all other patients were lost to follow-up; they were older (55 vs. 48 years, p = 0.01) and more likely to be undergoing work up to determine treatment eligibility (86 vs. 21%, p < 0.0001) than those not lost to follow-up.
  
  
  CONCLUSIONS
  Medical comorbidities and substance abuse predicted HCV treatment ineligibility in underserved African Americans. Importantly, the majority of those undergoing work-up to determine HCV treatment eligibility were lost to follow-up. While newer anti-HCV agents may increase treatment eligibility, culturally appropriate interventions to increase compliance with evaluation and care remain critical to HCV management in underserved African Americans.
authors: Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA. USA.
authors: Sarah
authors: S
authors: Schaeffer
authors: Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA. USA.
authors: Mandana
authors: M
authors: Khalili
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015897:Comorbidity; D057286:Electronic Health Records; D004608:Eligibility Determination; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000208:ethnology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000208:ethnology; D035862:Vulnerable Populations
chemical_list: D000998:Antiviral Agents