Burton H Jensie, Khatiwada Aastha, Chung Dongjun, Meissner Eric G
From the Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, the Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, and the Department of Biomedical Informatics, Ohio State University, Columbus.
South Med J. 2022 Jun;115(6):352-357. doi: 10.14423/SMJ.0000000000001402.
Therapeutic advances make the cure of chronic hepatitis C virus (HCV) infection achievable for individuals aware of their diagnosis who can access care. Identifying barriers to accessing care is critical to achieve population-level HCV elimination and improve the cascade of care from diagnosis to cure.
To identify barriers to HCV care, we performed a retrospective observational analysis of outcomes for patients with chronic HCV referred to an infectious diseases clinic at an academic medical center in Charleston, South Carolina between January 1, 2015 and January 1, 2020. We categorized outcomes in the cascade of care between "never presenting for evaluation" and "completed treatment with documented cure." Patient demographic factors, referral source, ZIP code of residence, insurance status, clinical characteristics, antiviral regimen, psychiatric and substance use history, and route of infection were assessed for associations with care outcomes.
Of 407 referrals, 32% of patients never presented for an initial evaluation, an outcome that was associated with active substance use, mental health disease, and referral from an emergency department or obstetrics-gynecology provider. Of the patients who presented for an initial evaluation, 78% of patients initiated treatment. Active substance use was the only variable associated with lack of therapy initiation after presenting for an initial evaluation (odds ratio 2.5, 95% confidence interval 1.07-5.84). Once treatment had been initiated, no clinical or demographic variables were associated with odds of achieving documented or presumed HCV cure.
Active substance use, mental health disease, and referral from an emergency department or obstetrics-gynecology provider were associated with a lower odds of presenting for evaluation and initiation of HCV treatment. Innovative models to improve access to care and increase outreach to vulnerable populations will be essential to eliminate HCV.
治疗方法的进步使慢性丙型肝炎病毒（HCV）感染的治愈对于那些知晓自身诊断且能获得治疗的个体成为可能。识别获得治疗的障碍对于实现群体层面的HCV消除以及改善从诊断到治愈的治疗流程至关重要。
为了识别HCV治疗的障碍，我们对2015年1月1日至2020年1月1日期间转诊至南卡罗来纳州查尔斯顿一家学术医疗中心传染病诊所的慢性HCV患者的结局进行了回顾性观察分析。我们将治疗流程中的结局分为“从未前来评估”和“完成治疗且有记录显示治愈”。评估患者的人口统计学因素、转诊来源、居住邮政编码、保险状况、临床特征、抗病毒治疗方案、精神病史和物质使用史以及感染途径与治疗结局的关联。
在407例转诊患者中，32%的患者从未前来进行初次评估，这一结局与当前物质使用、精神疾病以及来自急诊科或妇产科提供者的转诊有关。在前来进行初次评估的患者中，78%的患者开始治疗。当前物质使用是初次评估后未开始治疗的唯一相关变量（优势比2.5，95%置信区间1.07 - 5.84）。一旦开始治疗，没有临床或人口统计学变量与实现记录在案或推测的HCV治愈的几率相关。
当前物质使用、精神疾病以及来自急诊科或妇产科提供者的转诊与接受HCV评估和开始治疗的几率较低有关。创新模式以改善获得治疗的机会并增加对弱势群体的外展服务对于消除HCV至关重要。
