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Zhang H, Bao Y, Hutchings K, Shapiro MF, Kapadia SN. Association between claims-based setting of diagnosis and treatment initiation among Medicare patients with hepatitis C. Health Serv Res 2024; 59:e14330. [PMID: 38773839 PMCID: PMC11249812 DOI: 10.1111/1475-6773.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE To develop a claims-based algorithm to determine the setting of a disease diagnosis. DATA SOURCES AND STUDY SETTING Medicare enrollment and claims data from 2014 to 2019. STUDY DESIGN We developed a claims-based algorithm using facility indicators, revenue center codes, and place of service codes to identify settings where HCV diagnosis first appeared. When the first appearance was in a laboratory, we attempted to associate HCV diagnoses with subsequent clinical visits. Face validity was assessed by examining association of claims-based diagnostic settings with treatment initiation. DATA COLLECTION/EXTRACTION METHODS Patients newly diagnosed with HCV and continuously enrolled in traditional Medicare Parts A, B, and D (12 months before and 6 months after index diagnosis) were included. PRINCIPAL FINDINGS Among 104,454 patients aged 18-64 and 66,726 aged ≥65, 70.1% and 69%, respectively, were diagnosed in outpatient settings, and 20.2% and 22.7%, respectively in laboratory or unknown settings. Logistic regression revealed significantly lower odds of treatment initiation after diagnosis in emergency departments/urgent cares, hospitals, laboratories, or unclassified settings, than in outpatient visits. CONCLUSIONS The algorithm identified the setting of HCV diagnosis in most cases, and found significant associations with treatment initiation, suggesting an approach that can be adapted for future claims-based studies.
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Affiliation(s)
- Hao Zhang
- Department of Health Policy and OrganizationUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Yuhua Bao
- Department of Population Health SciencesWeill Cornell MedicineNew York CityNew YorkUSA
- Department of PsychiatryWeill Cornell MedicineNew York CityNew YorkUSA
| | - Kayla Hutchings
- Department of Population Health SciencesWeill Cornell MedicineNew York CityNew YorkUSA
| | - Martin F. Shapiro
- Division of General Internal MedicineWeill Cornell MedicineNew York CityNew YorkUSA
| | - Shashi N. Kapadia
- Department of Population Health SciencesWeill Cornell MedicineNew York CityNew YorkUSA
- Division of Infectious DiseasesWeill Cornell MedicineNew York CityNew YorkUSA
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2
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Chang SH, Su TH, Ling ZM, Lee MH, Liu CJ, Chen PJ, Yang HC, Liu CH, Chen CL, Tseng TC, Chen CH, Lee HS, Chen CJ, Kao JH. Fibrosis-4 index stratifies risks of hepatocellular carcinoma in patients with chronic hepatitis C. J Formos Med Assoc 2024:S0929-6646(24)00284-5. [PMID: 38944614 DOI: 10.1016/j.jfma.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/17/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND AND AIMS Risk stratification for patients with a higher risk of hepatocellular carcinoma (HCC) is crucial. We aimed to investigate the role of the Fibrosis-4 (FIB-4) index in predicting chronic hepatitis C (CHC)-related HCC. METHODS A retrospective cohort study consecutively included treatment-naive CHC patients receiving longitudinal follow-up at the National Taiwan University Hospital from 1986 to 2014. The clinical data were collected and traced for HCC development. Multivariable Cox proportional hazard regression analysis was used to investigate the predictors for HCC. RESULTS A total of 1285 patients in the ERADICATE-C cohort were included. The median age was 54, 56% were females, and 933 had HCV viremia. There were 33%, 38%, and 29% of patients having FIB-4 index <1.45, 1.45-3.25, and ≥3.25, respectively. After a median of 9-year follow-up, 186 patients developed HCC. Multivariable analysis revealed that older age, AFP≥20 ng/mL, cirrhosis, and a higher FIB-4 index were independent predictors for HCC. Compared with patients with FIB-4 index <1.45, those with FIB-4 1.45-3.25 had a 5.51-fold risk (95% confidence interval [CI]: 2.65-11.46), and those with FIB-4 ≥ 3.25 had 7.45-fold risk (95% CI: 3.46-16.05) of HCC. In CHC patients without viremia, FIB-4 index 1.45-3.25 and FIB-4 ≥ 3.25 increased 6.78-fold and 16.77-fold risk of HCC, respectively, compared with those with FIB-4 < 1.45. CONCLUSION The baseline FIB-4 index can stratify the risks of HCC in untreated CHC patients, even those without viremia. The FIB-4 index should thus be included in the management of CHC.
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Affiliation(s)
- Shan-Han Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Tung-Hung Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ze-Min Ling
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Jen Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Jer Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hung-Chih Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Hua Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tai-Chung Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Hsuan-Shu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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3
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Burraway J, Helbert B, Schexnayder J, Knick T, Dillingham R, Scherz C. Reliving it All Over Again: Uncanny Temporalities of Injection Drug Use and Hepatitis C Diagnosis in Southwest Virginia, USA. Med Anthropol 2023; 42:21-34. [PMID: 35944242 PMCID: PMC9822844 DOI: 10.1080/01459740.2022.2110090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Clinicians typically view the intersection between hepatitis C and injection drug use in terms of simultaneity - with transmission occurring via shared needles - or sequentially - with some states requiring that people stop using drugs prior to treatment. Yet, for patients, the connection between substance use and HCV infection can follow a more complex temporal pathway. In this article, we explore the non-linear temporality of "reliving" as it shapes HCV illness experience, its complex intersection with injection drug use, and the barriers patients face as they reckon with existing healthcare system responses and treatment modalities.
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Affiliation(s)
| | - Bailey Helbert
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Julie Schexnayder
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Terry Knick
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - China Scherz
- Department of Anthropology, University of Virginia, Charlottesville, Virginia, USA
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4
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Hosseini‐Hooshyar S, Alavi M, Martinello M, Valerio H, Tillakeratne S, Matthews GV, Dore GJ. Evaluation of the hepatitis C cascade of care among people living with HIV in New South Wales, Australia: A data linkage study. J Viral Hepat 2022; 29:271-279. [PMID: 35175671 PMCID: PMC9306975 DOI: 10.1111/jvh.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/09/2022]
Abstract
People living with HIV (PLHIV) are a priority population to receive hepatitis C virus (HCV) screening and treatment. We aimed to characterize the HCV care cascade among PLHIV between 2010 and 2018 and to compare HCV testing and treatment uptake pre- and post-availability of direct-acting antivirals (DAAs) in New South Wales (NSW), Australia. Records of all HCV notifications (1993-2017) were linked to HIV notifications, deaths, hospitalizations, incarcerations, opioid agonist therapy, HCV RNA testing and treatment databases. Numbers and proportions were calculated for all stages of the care cascade and factors associated with HCV testing, and DAA treatment uptake were evaluated using logistic regression. From 383 individuals with HCV notification (2009-2017), 349 (91%) were ever HCV RNA tested, 285 (74%) had an indicator of chronic HCV infection, and from those eligible for treatment, 210 (74%) received HCV treatment. HCV testing was recorded for 85% pre-DAA era and reached a cumulative proportion of 90% post-DAA while treatment uptake had a 10-fold increase from 7% pre- to 73% post-DAA era. Younger age (adjusted odds ratio [aOR] 0.98; 95% CI 0.96-0.99), female gender (aOR 1.87; 95% CI 1.10-3.19), and rural region residence at notification (aOR 1.56; 95% CI 1.03-2.36) were associated with not receiving HCV testing. No identified factor was associated with not receiving treatment post-DAA era. Removing barriers to HCV testing, expanding treatment to a variety of settings and continuous education and harm reduction are essential to achieve HCV elimination among PLHIV in Australia.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | | | - Heather Valerio
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | | | | | - Gregory J. Dore
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
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5
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Teshale EH, Roberts H, Gupta N, Jiles R. Characteristics of persons treated for hepatitis C using national pharmacy claims data, United States, 2014-2020. Clin Infect Dis 2022; 75:1078-1080. [PMID: 35171997 DOI: 10.1093/cid/ciac139] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Indexed: 01/13/2023] Open
Abstract
Using national pharmacy claims data, during 2014-2020, 843,329 persons were treated for hepatitis C at least once. The proportion treated increased annually among persons aged <40 years, insured by Medicaid, and treated by primary care providers. Monitoring hepatitis C treatment is essential to identify barriers to treatment access.
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Affiliation(s)
- Eyasu H Teshale
- Division of Viral Hepatitis; National Center for HIV, Viral Hepatitis, STD and TB Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry Roberts
- Division of Viral Hepatitis; National Center for HIV, Viral Hepatitis, STD and TB Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neil Gupta
- Division of Viral Hepatitis; National Center for HIV, Viral Hepatitis, STD and TB Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Jiles
- Division of Viral Hepatitis; National Center for HIV, Viral Hepatitis, STD and TB Prevention; Centers for Disease Control and Prevention, Atlanta, GA, USA
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6
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Wurcel AG, Guardado R, Beckwith CG. Hepatitis C Virus Is Associated With Increased Mortality Among Incarcerated Hospitalized Persons in Massachusetts. Open Forum Infect Dis 2021; 8:ofab579. [PMID: 34934776 PMCID: PMC8684448 DOI: 10.1093/ofid/ofab579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Hepatitis C virus (HCV) is curable, but incarcerated populations face barriers to treatment. In a cohort of incarcerated hospitalized patients in Boston, Massachusetts, HCV infection was associated with increased mortality. Access to HCV treatment in carceral settings is crucial to avoid unnecessary death and to support HCV elimination efforts.
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Affiliation(s)
- Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine Tufts Medical Center, Boston, Massachusetts, USA.,Tufts University School of Medicine, Boston Massachusetts, USA
| | - Rubeen Guardado
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine Tufts Medical Center, Boston, Massachusetts, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, USA
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7
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Yousafzai MT, Bajis S, Alavi M, Grebely J, Dore GJ, Hajarizadeh B. Global cascade of care for chronic hepatitis C virus infection: A systematic review and meta-analysis. J Viral Hepat 2021; 28:1340-1354. [PMID: 34310812 DOI: 10.1111/jvh.13574] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/22/2021] [Accepted: 06/26/2021] [Indexed: 12/14/2022]
Abstract
The World Health Organization 2030 targets for hepatitis C virus (HCV) elimination include diagnosing 90% of people with HCV and treating 80% of people diagnosed with HCV. This systematic review assessed reported data on the HCV care cascade in various countries and populations, with a focus on direct-acting antiviral (DAA) treatment uptake. Bibliographic databases and conference presentations were searched for studies reporting the HCV care cascade (DAA treatment uptake was a requirement) among the overall population with HCV or sub-populations at greater risk of HCV. Population-based studies, with participants representative of a city, province/state or country were eligible. Twenty eligible studies were included, reporting HCV care cascade in 28 populations/sub-populations from 11 countries. DAA treatment uptake at national levels was reported from Iceland (95%), Egypt (92%), Georgia (79%), Norway (18%) and Sweden (8%), and at sub-national levels from the Netherlands (52%), Canada (50%), the United States (29%) and Denmark (5%). Among people with HIV-HCV co-infection, DAA treatment uptake was 62% in Canada, 44% in the Netherlands, 21% in Switzerland and 18% in the United States. Among people who inject drugs, DAA treatment uptake was 50% in Georgia, 40% in Canada, 37% in Australia and 13% in the United States. Data among people experiencing homelessness were only available from the United States (treatment uptake: 12%-14%). We found no eligible study reporting HCV care cascade data in prisons. Relatively few countries reported HCV care cascade at the national level. DAA treatment uptake was widely varied across populations/sub-populations, with higher rates reported in recent years.
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Affiliation(s)
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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8
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Kaufman HW, Bull-Otterson L, Meyer WA, Huang X, Doshani M, Thompson WW, Osinubi A, Khan MA, Harris AM, Gupta N, Van Handel M, Wester C, Mermin J, Nelson NP. Decreases in Hepatitis C Testing and Treatment During the COVID-19 Pandemic. Am J Prev Med 2021; 61:369-376. [PMID: 34088556 PMCID: PMC8107198 DOI: 10.1016/j.amepre.2021.03.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to conduct routine hepatitis C virus antibody screening, clinical care, and treatment. Therefore, people living with undiagnosed hepatitis C virus during the pandemic may later become identified at more advanced stages of the disease, leading to higher morbidity and mortality rates. Further, unidentified hepatitis C virus-infected individuals may continue to unknowingly transmit the virus to others. METHODS To assess the impact of the COVID-19 pandemic, data were evaluated from a large national reference clinical laboratory and from national estimates of dispensed prescriptions for hepatitis C virus treatment. Investigators estimated the average number of hepatitis C virus antibody tests, hepatitis C virus antibody-positive test results, and hepatitis C virus RNA-positive test results by month in January-July for 2018 and 2019, compared with the same months in 2020. To assess the impact of hepatitis C virus treatment, dispensed hepatitis C virus direct-acting antiretroviral medications were examined for the same time periods. Statistical analyses of trends were performed using negative binomial models. RESULTS Compared with the 2018 and 2019 months, hepatitis C virus antibody testing volume decreased 59% during April 2020 and rebounded to a 6% reduction in July 2020. The number of hepatitis C virus RNA-positive results fell by 62% in March 2020 and remained 39% below the baseline by July 2020. For hepatitis C virus treatment, prescriptions decreased 43% in May, 37% in June, and 38% in July relative to the corresponding months in 2018 and 2019. CONCLUSIONS During the COVID-19 pandemic, continued public health messaging, interventions and outreach programs to restore hepatitis C virus testing and treatment to prepandemic levels, and maintenance of public health efforts to eliminate hepatitis C infections remain important.
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Affiliation(s)
| | - Lara Bull-Otterson
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Mona Doshani
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William W Thompson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ademola Osinubi
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mohammed A Khan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron M Harris
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neil Gupta
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle Van Handel
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn Wester
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Noele P Nelson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Spradling PR, Zhong Y, Moorman AC, Rupp LB, Lu M, Gordon SC, Teshale EH, Schmidt MA, Daida YG, Boscarino JA. Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure. Hepatol Commun 2021; 5:400-411. [PMID: 33681675 PMCID: PMC7917278 DOI: 10.1002/hep4.1632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
There are limited data examining the relationship between psychosocial factors and receipt of direct-acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health-related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017-2018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow-up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life-related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow-up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). Conclusion: In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C-related morbidity and mortality.
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Affiliation(s)
- Philip R Spradling
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Yuna Zhong
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Anne C Moorman
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | | | - Mei Lu
- Henry Ford Health SystemDetroitMIUSA
| | - Stuart C Gordon
- Henry Ford Health SystemDetroitMIUSA.,Wayne State University School of MedicineDetroitMIUSA
| | - Eyasu H Teshale
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Mark A Schmidt
- Center for Health ResearchKaiser Permanente NorthwestPortlandORUSA
| | - Yihe G Daida
- Center for Integrated Health Care ResearchKaiser Permanente HawaiiHonoluluHIUSA
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10
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Yunihastuti E, Wicaksana B, Wiraguna A, Hidayah AJ, Amelia F, Natali V, Widhani A, Sulaiman AS, Kurniawan J. Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients. BMC Infect Dis 2020; 20:372. [PMID: 32450844 PMCID: PMC7249442 DOI: 10.1186/s12879-020-05069-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
Background After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard. Method This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves. Results 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63–0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65–0.81)] and correctly classified 81.1% of the patients. Conclusion APRI score ≥ 1 and FIB-4 score ≥ 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.
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Affiliation(s)
- Evy Yunihastuti
- HIV integrated services, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. .,Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Diponegoro, Jakarta, 71, Indonesia.
| | | | - Andrian Wiraguna
- HIV integrated services, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Fhadilla Amelia
- HIV integrated services, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Veritea Natali
- HIV integrated services, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Alvina Widhani
- HIV integrated services, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Diponegoro, Jakarta, 71, Indonesia
| | - Andri Sanityoso Sulaiman
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Diponegoro, Jakarta, 71, Indonesia
| | - Juferdy Kurniawan
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Diponegoro, Jakarta, 71, Indonesia
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