Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX.
Parkland Health and Hospital System, Dallas, TX.
Medical Technology and Practice Patterns Institute, Bethesda, MD.
Multi-Organ Transplant Institute, Ochsner Health System, New Orleans, LA.
Liver Institute of Virginia, Bon Secours Health System, Richmond, VA.
Division of Gastroenterology and & Hepatology, Alameda Health System - Highland, Hospital, Oakland, CA.
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.
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).
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.
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).
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.