Access to HCV Therapy Has Not Improved for Patients With Mental Health or Substance Use Disorders
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Direct-acting antivirals (DAA) for hepatitis C virus (HCV) became available in 2014, but the role of mental health or substance use disorders (MH/SUD) on access to treatment is unknown.
OBJECTIVE
To examine extent and predictors of HCV treatment in the pre-DAA and post-DAA periods in 4 large, diverse health care settings in the United States (US).
METHODS
Retrospective analysis of 29,544 adults with chronic HCV who did or did not receive treatment from 1/1/11-2/28/17. Kaplan Meier curve was used to examine cumulative risk for receiving HCV treatment stratified by MH/SUD. Predictors of HCV treatment in the pre-DAA (1/1/11-12/31/13) and post-DAA (1/1/14-2/28/17) cohorts were analyzed using multivariate generalized estimating equations (GEE) and a modified Poisson models.
RESULTS
Overall 21.7% (2,879/13,240) of those with chronic HCV post-DAA were treated compared to 3.5% (574/16,304) in the pre-DAA period. Compared to non-Hispanic Whites, Hispanic Whites (AOR 0.36, 95% CI: 0.25, 0.52) were less likely to be treated in the post-DAA period. Those with concurrent nonalcoholic fatty liver disease (AOR 1.39, 95% CI: 1.05, 1.83), cirrhosis (AOR 2.00, 95% CI: 1.74, 2.31), and liver transplant (AOR 2.72, 95% CI: 1.87, 3.94) were more likely to be treated post-DAA. Those with MH/SUD were less likely to be treated both before (AOR 0.46, 95% CI: 0.36, 0.60) and after (AOR 0.63, 95% CI:0.55,0.71) DAA therapy was available. Overall, the cumulative risk for receiving HCV treatment from 2011-17 among those with vs. without MH/SUD was 13.6% vs. 21.6%, respectively, (P <0.001).
CONCLUSIONS
The volume of patients treated for HCV has increased in the post-DAA period especially among those with liver-related co-morbidities, but disparities in access to treatment continue among those with MH/SUD.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Has Access to HCV Therapy Changed for Patients With Mental Health or Substance Use Disorders in the DAA Period?
Hepatology 2018 Jul 17;[EPub Ahead of Print], MK Jain, M Thamer, G Therapondos, ML Shiffman, O Kshirsagar, C Clark, RJ WongFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.