Patient Engagement is the Predominant Barrier to Completing Hepatitis C Virus Treatment in the Pan-Genotypic Direct-Acting Antiviral Era

Author(s): Clara Y. Tow, MD, Meera Bhardwaj, MD, Kazi Ullah, MD, Jellyanna Peraza, MD, Xianhong Xie, PhD, Melissa Fazzari, PhD, MS, Marouf Houssain, MD, Brett Fortune, MD, MS

Background:

Data regarding real-world barriers patients encounter along the hepatitis C (HCV) care continuum is limited since the availability of pan-genotypic direct-acting antivirals (DAA). We sought to evaluate the HCV cascade of care during the pan-genotypic DAA era at an academic health system with multiple hospital and clinic sites in a large, diverse urban population.

Methods:

We conducted a retrospective cohort study of adult patients with chronic HCV at a single, academic health system between January 1, 2017 to September 30, 2019. The primary outcome evaluated was completion of DAA. Secondary outcomes included successful progression through each stage of the HCV care continuum from diagnosis to cure.

Results:

1215 patients were included. The average age was 61.5 years old and 62% were men. 84.5% had public insurance. All patients were referred to an HCV treatment provider. 550 patients (45.3%) met with an HCV treatment provider. 189 patients (15.6%) completed DAA. Active intravenous drug use, a mental health disorder, being referred by the emergency room or inpatient setting were associated with HCV treatment not being completed. Treatment by hepatology and infectious diseases and living closer to the treatment clinic was associated with treatment completion. Undergoing fibrosis staging, resistance testing, receiving medication education, and attending more clinic visits during the treatment course was also associated with treatment completion. Virologic response at 12 and 24 weeks was inconsistently obtained.

Conclusion:

In a predominantly under-represented minority, urban population with public insurance, significant barriers to HCV treatment with pan-genotypic DAAs continue to exist.