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Ziff J, Vu T, Dvir D, Riazi F, Toribio W, Oster S, Sigel K, Weiss J. Predictors of hepatitis C treatment outcomes in a harm reduction-focused primary care program in New York City. Harm Reduct J 2021; 18:38. [PMID: 33789691 PMCID: PMC8010955 DOI: 10.1186/s12954-021-00486-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background The social determinants of health that influence steps in the entire Hepatitis C Virus (HCV) treatment cascade must be identified to achieve HCV elimination goals. This project aimed to evaluate the association of these factors with HCV treatment completion and return for sustained virologic response (SVR) testing. Methods We used retrospective cohort data from our primary care-based HCV treatment program that provides comprehensive harm reduction care to those who use or formerly used drugs. Among persons who began direct-acting antiviral HCV treatment between December 2014 and March 2018, we identified two outcomes: HCV treatment completion and return for SVR assessment 12 weeks after treatment end. Several predictors were ascertained including sociodemographic information, substance use, psychiatric symptoms and history, housing instability, and HCV treatment regimen. We then evaluated associations between predictors and outcomes using univariate and multivariable statistical methods. Results From a cohort of 329 patients treated in an urban primary care center, multivariable analysis identified housing instability as a single significant predictor for HCV treatment completion (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.1–0.9). Among patients completing treatment, 226 (75%) returned for SVR assessment; the sole predictor of this outcome was Medicaid as primary insurance (compared to other insurances; OR 0.3; 0.1–0.7). Conclusions Innovative strategies to help unstably housed persons complete HCV treatment are urgently needed in order to reach HCV elimination targets. Educational and motivational strategies should be developed to promote individuals with Medicaid in particular to return for SVR viral load testing, a critical post-treatment component of the HCV treatment cascade. Trial registration Not applicable.
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Affiliation(s)
- Jacob Ziff
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States.
| | - Trang Vu
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Danielle Dvir
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Farah Riazi
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Wilma Toribio
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Scott Oster
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Keith Sigel
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Jeffrey Weiss
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
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Khalili M, Wong RJ. Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net. Dig Dis Sci 2018. [PMID: 30311153 DOI: 10.1007/12] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The availability of the new generation of direct-acting antiviral (DAA) therapies for the treatment of chronic hepatitis C virus (HCV) infection has completely transformed the HCV therapeutic landscape. Current regimens provide pan-genotypic coverage that are of short duration, safer, and are highly effective than prior generations of HCV therapeutics. While data from clinical trials and real-world experience continue to demonstrate similar and high sustained virologic response (SVR) rates, the successful implementation of the HCV cascade-of-care including screening, confirmation of active infection, treatment initiation and successful completion of therapy among more challenging populations, such as the underserved populations who are also disproportionally affected by HCV, remains vital to HCV eradication efforts.
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Affiliation(s)
- Mandana Khalili
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA.
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA, USA
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Abstract
The availability of the new generation of direct-acting antiviral (DAA) therapies for the treatment of chronic hepatitis C virus (HCV) infection has completely transformed the HCV therapeutic landscape. Current regimens provide pan-genotypic coverage that are of short duration, safer, and are highly effective than prior generations of HCV therapeutics. While data from clinical trials and real-world experience continue to demonstrate similar and high sustained virologic response (SVR) rates, the successful implementation of the HCV cascade-of-care including screening, confirmation of active infection, treatment initiation and successful completion of therapy among more challenging populations, such as the underserved populations who are also disproportionally affected by HCV, remains vital to HCV eradication efforts.
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Affiliation(s)
- Mandana Khalili
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA
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