Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
J Gen Intern Med. 2019 Oct;34(10):2005-2013. doi: 10.1007/s11606-018-4649-6. Epub 2018 Sep 20.
Birth cohort screening is recommended for hepatitis C virus (HCV) and underserved populations are disproportionally affected by HCV. Little is known about the influence of race on the HCV care continuum in this population.
To assess the cascade of HCV care in a large racially diverse and underserved birth cohort.
Retrospective cohort study using electronic medical record data abstracted until August 31, 2017.
34,810 patients born between 1945 and 1965 engaged in primary care between October 1, 2014, and October 31, 2016, within the safety-net clinics of the San Francisco Health Network.
Rate of hepatitis C testing, hepatitis C treatment, and response to therapy.
Cohort characteristics were as follows: median age 59 years, 57.6% male, 25.5% White (20.6% Black, 17.7% Latino, 33.0% Asian/Pacific Islander (API), 2% other), and 32.6% preferred a non-English language. 99.7% had an HCV test (95.4% HCV antibody, 4.3% HCVRNA alone). Among HCV antibody-positive patients (N = 4587), 22.9% were not tested for confirmatory HCVRNA. Among viremic patients (N = 3673), 20.8% initiated HCV therapy, 90.6% achieved sustained virologic response (SVR) and 8.1% did not have a SVR test. HCV screening and treatment were highest in APIs (98.7 and 34.7% respectively; p < 0.001). Blacks had the highest chronic HCV rate (22.2%; p < 0.001). Latinos had the lowest SVR rate (81.3%; p = 0.01). On multivariable analysis, API race (vs White, OR 1.20; p = 0.001), presence of HIV co-infection (OR 1.58; p = 0.02), presence of chronic kidney disease (OR 0.47; p < 0.001), English (vs non-English) as preferred language (OR 0.54; p = 0.002), ALT (OR 0.39 per doubling; p < 0.001), and HCVRNA (OR 0.83 per 10-fold increase; p < 0.001) were associated with HCV treatment.
Despite near-universal screening, gaps in active HCV confirmation, treatment, and verification of cure were identified and influenced by race. Tailored interventions to engage and treat diverse and underserved populations with HCV infection are needed.
推荐对肝炎 C 病毒（HCV）进行出生队列筛查，而服务不足的人群则不成比例地受到 HCV 的影响。对于种族对该人群 HCV 护理连续体的影响，人们知之甚少。
评估在一个种族多样化且服务不足的大型出生队列中 HCV 护理的连续体。
使用电子病历数据进行的回顾性队列研究，数据截至 2017 年 8 月 31 日。
2014 年 10 月 1 日至 2016 年 10 月 31 日期间，在旧金山卫生网络的安全网诊所内接受初级保健的 1945 年至 1965 年间出生的 34810 名患者。
丙型肝炎检测率、丙型肝炎治疗率和治疗反应率。
队列特征如下：中位年龄 59 岁，57.6%为男性，25.5%为白人（20.6%为黑人，17.7%为拉丁裔，33.0%为亚太裔/太平洋岛民（API），2%为其他），32.6%更喜欢非英语语言。99.7%接受了 HCV 检测（95.4% HCV 抗体，4.3% HCVRNA 单独检测）。在 HCV 抗体阳性患者（N=4587）中，22.9%未进行 HCVRNA 确认检测。在病毒血症患者（N=3673）中，20.8%开始接受 HCV 治疗，90.6%获得持续病毒学应答（SVR），8.1%未进行 SVR 检测。API 的 HCV 筛查和治疗率最高（分别为 98.7%和 34.7%；p<0.001）。黑人的慢性 HCV 率最高（22.2%；p<0.001）。拉丁裔的 SVR 率最低（81.3%；p=0.01）。多变量分析显示，API 种族（与白人相比，OR 1.20；p=0.001）、合并 HIV 感染（OR 1.58；p=0.02）、慢性肾脏病（OR 0.47；p<0.001）、首选英语（OR 0.54；p=0.002）、丙氨酸转氨酶（OR 0.39 每增加一倍；p<0.001）和 HCVRNA（OR 0.83 每增加 10 倍；p<0.001）与 HCV 治疗相关。
尽管进行了近乎普遍的筛查，但仍发现了 HCV 确认、治疗和治愈验证方面的差距，这些差距受到种族的影响。需要针对不同种族和服务不足的 HCV 感染人群制定有针对性的干预措施，以进行接触和治疗。
