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- Title
Persistent Challenges in the Hepatitis C Virus Care Continuum for Patients in a Central Texas Public Health System.
- Authors
Reader, Shane W; Kim, Hyun-seok; El-Serag, Hashem B; Thrift, Aaron P
- Abstract
Background Direct-acting antiviral treatment regimens cure >95% of chronic hepatitis C virus (HCV) infections, but recent studies indicate that <25% of patients in the United States receive treatment. Patients need to overcome barriers on the steps of the care continuum in order to be prescribed treatment. We aimed to examine the steps of the HCV care continuum up to prescription of HCV therapy among patients receiving care within a large safety net health care system in Houston, Texas. Methods We used electronic medical records to identify patients with positive screening tests for HCV antibodies between July 1, 2017, and June 30, 2018, and abstracted data on their advancement through the care continuum for HCV. We used logistic regression to identify factors associated with patient navigation through the continuum. Results Of the 2450 patients screening positive for HCV antibodies, 2016 (82.3%) received quantitative RNA testing, of whom 1081 (53.6%) exhibited chronic infection. Providers referred 915 (84.6%) to specialty care for evaluation, 540 of these patients (50.0%) received their specialist evaluation, and 299 (27.7%) received a prescription for treatment. Patients with history of substance use were less likely to be prescribed treatment (adjusted odds ratio, 0.66; 95% CI, 0.49–0.88). Conclusions We found substantial attrition at each stage of the HCV care continuum. In particular, history of substance abuse was a predictor of nonprescription. Challenges in the care continuum motivate increased provider education as well as the adoption of recent innovations in patient care.
- Subjects
HOUSTON (Tex.); TEXAS; CONTINUUM of care; HEPATITIS C virus; CHRONIC hepatitis C; MEDICAL records; ELECTRONIC health records; SAFETY-net health care providers
- Publication
Open Forum Infectious Diseases, 2020, Vol 7, Issue 8, p1
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofaa322