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- Title
Health Insurance and Initiation of Direct-Acting Antivirals for Hepatitis C in US Women With Human Immunodeficiency Virus.
- Authors
Edmonds, Andrew; Haley, Danielle F; Edwards, Jessie K; Ramirez, Catalina; French, Audrey L; Tien, Phyllis C; Plankey, Michael; Sharma, Anjali; Augenbraun, Michael; Seaberg, Eric C; Workowski, Kimberly; Alcaide, Maria L; Albrecht, Svenja; Adimora, Adaora A
- Abstract
Background Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is well tolerated, cost-effective, and yields high sustained virologic response rates, yet it has remained financially inaccessible to many patients. Methods Participants of the Women's Interagency HIV Study (an observational US cohort) with human immunodeficiency virus (HIV) and HCV (RNA+) reporting no prior hepatitis C treatment were followed for DAA initiation (2015–2019). We estimated risk ratios (RRs) of the relationship between time-varying health insurance status and DAA initiation, adjusting for confounders with stabilized inverse probability weights. We also estimated weighted cumulative incidences of DAA initiation by health insurance status. Results A total of 139 women (74% Black) were included; at baseline, the median age was 55 years and 86% were insured. Most had annual household incomes ≤$18 000 (85%); advanced liver fibrosis (21%), alcohol use (45%), and recreational drug use (35%) were common. Across 439 subsequent semiannual visits, 88 women (63%) reported DAA initiation. Compared with no health insurance, health insurance increased the likelihood of reporting DAA initiation at a given visit (RR, 4.94; 95% confidence limit [CL], 1.92 to 12.8). At 2 years, the weighted cumulative incidence of DAA initiation was higher among the insured (51.2%; 95% CL, 43.3% to 60.6%) than the uninsured (3.5%; 95% CL, 0.8% to 14.6%). Conclusions Accounting for clinical, behavioral, and sociodemographic factors over time, health insurance had a substantial positive effect on DAA initiation. Interventions to increase insurance coverage should be prioritized to increase HCV curative therapy uptake for persons with HIV.
- Subjects
UNITED States; HEALTH services accessibility; CONFIDENCE intervals; VIRAL load; BLACK people; HEPATITIS C; ANTIVIRAL agents; TREATMENT effectiveness; COST benefit analysis; COMPARATIVE studies; INCOME; PSYCHOLOGY of women; HEALTH insurance; DESCRIPTIVE statistics; RESEARCH funding; ODDS ratio; PSYCHOLOGY of HIV-positive persons
- Publication
Clinical Infectious Diseases, 2023, Vol 77, Issue 2, p258
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad204