title: Lack of health insurance limits the benefits of hepatitis C virus screening: insights from the National Health and Nutrition Examination Hepatitis C follow-up study.
abstract: OBJECTIVE
  Identifying barriers to access to hepatitis C virus (HCV) treatment among screen detected subjects is critical for any public health strategy aimed at controlling HCV infection in the general population.
  
  
  METHODS
  Data from the National Health and Nutrition Examination Survey HCV Follow-up study from 2001 to 2010 were used. Participants who tested positive for HCV were sent a letter informing them of their test results and advised to pursue further evaluation. Information on HCV transmission and its potential complications was also provided to all positive participants. These subjects were recontacted 6 months after notification to determine what action they had taken regarding the positive result.
  
  
  RESULTS
  Of 38,025 participants, 502 tested positive for HCV infection, giving a prevalence of 1.3% (95% confidence interval (CI) 0.8%, 1.8%). A total of 205 subjects participated in the 6-month follow-up interview. Those who could not be reached were more likely to be less educated, injecting drugs, and not to have health insurance. Half (50.2%) of the positive individuals were not aware of their status before notification. A total of 166 (81%) had pursued further evaluation. Only 18 (26.9%) received therapy. The main reason for not receiving treatment was high cost (19.4%). In adjusted analysis, the only barrier to pursuing downstream HCV care was the lack of health insurance (2.76, 95% CI 1.54, 7.69; P=0.007).
  
  
  CONCLUSIONS
  This study suggests that the lack of health insurance may attenuate the theoretical benefits of a screening program that identifies asymptomatic HCV-infected individuals who are less likely to pursue downstream care.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ivo
authors.initials: I
authors.lastname: Ditah
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Badr
authors.initials: B
authors.lastname: Al Bawardy
authors.affiliation: Department of Transplant Surgery, Methodist University Hospital, University of Tennessee, Memphis, Tennessee, USA.
authors.forename: Humberto C
authors.initials: HC
authors.lastname: Gonzalez
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Behnam
authors.initials: B
authors.lastname: Saberi
authors.affiliation: University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Callistus
authors.initials: C
authors.lastname: Ditah
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Hepatology and Liver Transplantation, Intermountain Medical Center, Salt Lake City, Utah, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Charlton
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics*; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009749:Nutrition Surveys; D014481:United States