title: Treating Hepatitis C in a Ryan White-Funded HIV Clinic: Has the Treatment Uptake Improved in the Interferon-Free Directly Active Antiviral Era?
abstract: Now that highly efficacious, interferon-free (IFN-free), direct acting antivirals (DAA) for the treatment of hepatitis C (HCV) have closed the gap between treatment and cure, identifying barriers that prevent initiation of treatment is more crucial than ever. This is a retrospective study utilizing Electronic Medical Records and Prior Authorization Records to identify HCV treatment gaps, including predictors for intention-to-treat and treatment initiation in the first 15 months of a Ryan White funded human immunodeficiency virus (HIV)/HCV co-infection clinic. This study included 128 adults ≥ 18 years old with HIV and chronic HCV infection who had visited the treatment center at least once since January 2013. Provider intent-to-treat was used to differentiate patients actively considered for treatment based on documentation kept by a multidisciplinary HCV team. Members of this group who had gone on to initiate treatment were identified. Baseline characteristics were compared. Rates of active treatment consideration and treatment initiation were 30% and 14%, respectively. HCV treatment-naïve individuals were less likely to be considered for treatment [risk ratio (RR) 1.58, 95% confidence interval (CI) 1.07-2.32] and initiate therapy (RR 2.33, 95% CI 0.97-5.60). Advanced liver disease had no significant association. Black race (RR 1.96, 95% CI 0.90-4.25) and Medicaid insurance holders (RR 1.90, 95% CI 0.95-3.82) tended to be less likely to initiate therapy. The availability of IFN-free DAA regimens has yet to increase HCV treatment uptake in our HIV/HCV co-infected population. Barriers to HCV treatment initiation have shifted from medical contraindications to socioeconomic variables.
authors.affiliation: 1 University of Pittsburgh School of Pharmacy , Pittsburgh, Pennsylvania (at time of research).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cope
authors.affiliation: 2 Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Thomas
authors.initials: T
authors.lastname: Glowa
authors.affiliation: 2 Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Samantha
authors.initials: S
authors.lastname: Faulds
authors.affiliation: 2 Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Deborah
authors.initials: D
authors.lastname: McMahon
authors.affiliation: 2 Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy / Q000821:virology*; D004347:Drug Interactions; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D016174:Hepacivirus / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons