Foppiano Palacios Carlo, Dubose Brianna, Schmalzle Sarah
Department of Medicine, Cooper University Hospital, Camden, USA.
Departments of Internal Medicine and Pediatrics, University of Maryland Medical Center, Baltimore, USA.
Cureus. 2024 Apr 15;16(4):e58313. doi: 10.7759/cureus.58313. eCollection 2024 Apr.
Background Modern direct-acting antivirals (DAAs) can treat and cure hepatitis C virus (HCV) infection. Treatment of HCV at a population level has the potential to decrease the prevalence of chronic HCV infection and sequela. Unfortunately, many patients fall off the HCV treatment cascade and do not complete HCV treatment. As social determinants of health (SDHs) affect HCV acquisition, we sought to evaluate factors that may limit successful linkage to outpatient HCV care. Methods We conducted a case-control study by matching patients who missed and those who attended their outpatient HCV visits in 2018. We matched cases in a 1:1 ratio using propensity scores. Results Of 1,539 patients, 161 (10.5%) did not attend their HCV clinic appointment. Factors associated with a missed HCV visit on bivariate testing included identifying as Black (p=0.03), housing instability (p<0.001), transportation difficulty (p<0.001), history of medication non-adherence (p<0.001), and undergoing screening during an inpatient admission (p<0.001). Multivariate testing found transportation difficulty (p<0.001) and inpatient admission (p=0.002) to be associated with missing their HCV appointment. Patients who attended their HCV visit were more likely to be alive by the end of 2018 (p=0.07). Conclusion Patients who missed an initial scheduled infectious disease (ID) clinic appointment for HCV treatment had higher rates of housing instability, transportation difficulties, and medication non-adherence. Patients diagnosed with HCV infection should be provided additional support as appropriate to address the social determinants of health that may limit linkage to outpatient HCV care.
背景 现代直接抗病毒药物（DAAs）可治疗并治愈丙型肝炎病毒（HCV）感染。在人群层面治疗HCV有可能降低慢性HCV感染及其后遗症的患病率。遗憾的是，许多患者未能完成HCV治疗流程，未完成HCV治疗。由于健康的社会决定因素（SDH）会影响HCV感染情况，我们试图评估可能限制成功与门诊HCV护理建立联系的因素。方法 我们通过匹配2018年错过和参加门诊HCV就诊的患者进行了一项病例对照研究。我们使用倾向得分以1:1的比例匹配病例。结果 在1539名患者中，161名（10.5%）未参加HCV门诊预约。双变量检测中与错过HCV就诊相关的因素包括认定为黑人（p = 0.03）、住房不稳定（p < 0.001）、交通困难（p < 0.001）、药物治疗不依从史（p < 0.001）以及住院期间接受筛查（p < 0.001）。多变量检测发现交通困难（p < 0.001）和住院（p = 0.002）与错过HCV预约相关。参加HCV就诊的患者在2018年底存活的可能性更高（p = 0.07）。结论 错过初次预定的HCV治疗传染病（ID）门诊预约的患者住房不稳定、交通困难和药物治疗不依从的发生率更高。对于被诊断为HCV感染的患者，应酌情提供额外支持，以解决可能限制与门诊HCV护理建立联系的健康社会决定因素。
