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Abstract Details
Direct-acting antiviral Hepatitis C treatment cascade and barriers to treatment initiation among US men and women with and without HIV
J Infect Dis. 2020 Nov 3;jiaa686. doi: 10.1093/infdis/jiaa686. Online ahead of print.
Danielle F Haley1, Andrew Edmonds2, Catalina Ramirez3, Audrey L French4, Phyllis Tien5, Chloe L Thio6, Mallory D Witt7, Eric C Seaberg8, Michael W Plankey9, Mardge H Cohen10, Adaora A Adimora11
Author information
1Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
2Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
3Divison of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill and Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
4Division of Infectious Diseases, Stroger (Cook County) Hospital, Chicago, IL, USA.
5Department of Medicine, University of California San Francisco and Department of Veterans Affairs Medical Center, San Francisco, CA, USA.
6Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
7Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA.
8Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
9Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
10Department of Medicine, Stroger (Cook County) Hospital, Chicago, IL, USA.
11Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill and Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Abstract
Background: People with HIV are disproportionately co-infected with hepatitis C virus (HCV) and experience accelerated liver-related mortality. Direct-acting antivirals (DAAs) yield high sustained virologic response (SVR) rates, but uptake is suboptimal. This study characterizes the DAA-era HCV treatment cascade and barriers among US men and women with or at risk for HIV.
Methods: We constructed HCV treatment cascades using data from The Women's Interagency HIV Study (women, six visits, 2015-2018, n=2,447) and Multicenter AIDS Cohort Study (men, one visit, 2015-2018, n=2,221). Cascades included treatment-eligible individuals (i.e., HCV RNA+ or reported DAAs). Surveys captured self-reported clinical (e.g., CD4), patient (e.g., missed visits), system (e.g., appointment access), and financial/insurance barriers.
Results: 323 women and 92 men were treatment-eligible. Most women/men had HIV (77%/70%); 69%/63% were Black. HIV+ women were more likely to attain cascade outcomes than HIV- women (39% vs. 23% initiated, 21% vs. 12% SVR); similar discrepancies were noted for men. Black men and substance users were treated less often. Women initiating treatment (vs. not) reported fewer patient (14%/33%) barriers. Among men not treated, clinical barriers were prevalent (53%).
Conclusions: HIV care may facilitate HCV treatment linkage and barrier navigation. HIV- individuals, Black men, and substance users may need additional support.