title: Correlates of Initiation of Treatment for Chronic Hepatitis C Infection in United States Veterans, 2004-2009.
abstract: We describe the rates and predictors of initiation of treatment for chronic hepatitis C (HCV) infection in a large cohort of HCV positive Veterans seen in U.S. Department of Veterans Affairs (VA) facilities between January 1, 2004 and December 31, 2009. In addition, we identify the relationship between homelessness among these Veterans and treatment initiation. Univariate and multivariable Cox Proportional Hazards regression models with time-varying covariates were used to identify predictors of initiation of treatment with pegylated interferon alpha plus ribavirin. Of the 101,444 HCV treatment-naïve Veterans during the study period, rates of initiation of treatment among homeless and non-homeless Veterans with HCV were low and clinically similar (6.2% vs. 7.4%, p<0.0001). For all U.S. Veterans, being diagnosed with genotype 2 or 3, black or other/unknown race, having Medicare or other insurance increased the risk of treatment. Veterans with age ≥50 years, drug abuse, diabetes, and hemoglobin < 10 g/dL showed lower rates of treatment. Initiation of treatment for HCV in homeless Veterans is low; similar factors predicted initiation of treatment. Additionally, exposure to treatment with medications for diabetes predicted lower rates of treatment. As newer therapies become available for HCV, these results may inform further studies and guide strategies to increase treatment rates in all U.S. Veterans and those who experience homelessness.
authors.affiliation: Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America; University of Utah School of Medicine, Salt Lake City, Utah, United States of America.
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
authors.affiliation: Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America; University of Utah School of Medicine, Salt Lake City, Utah, United States of America.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America; University of Utah School of Medicine, Salt Lake City, Utah, United States of America.
authors.forename: Candace
authors.initials: C
authors.lastname: Haroldsen
authors.affiliation: Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America; University of Utah School of Medicine, Salt Lake City, Utah, United States of America.
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Carter
authors.affiliation: Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America; University of Utah College of Pharmacy, Salt Lake City, Utah, United States of America.
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D015995:Prevalence; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b