Race and Hepatitis C Care Continuum in an Underserved Birth Cohort.
Black or African American
/ statistics & numerical data
Antiviral Agents
/ therapeutic use
Continuity of Patient Care
/ standards
Diagnostic Tests, Routine
/ statistics & numerical data
Drug Utilization
/ statistics & numerical data
Electronic Health Records
Female
Hepacivirus
/ isolation & purification
Hepatitis C, Chronic
/ diagnosis
Humans
Male
Mass Screening
/ standards
Middle Aged
Primary Health Care
/ standards
Retrospective Studies
San Francisco
Sustained Virologic Response
Treatment Outcome
Vulnerable Populations
/ ethnology
African American
direct-acting antivirals
health disparity
linkage to care
vulnerable populations
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
14
06
2018
accepted:
18
08
2018
pubmed:
22
9
2018
medline:
20
6
2020
entrez:
22
9
2018
Statut:
ppublish
Résumé
Birth cohort screening is recommended for hepatitis C virus (HCV) and underserved populations are disproportionally affected by HCV. Little is known about the influence of race on the HCV care continuum in this population. To assess the cascade of HCV care in a large racially diverse and underserved birth cohort. Retrospective cohort study using electronic medical record data abstracted until August 31, 2017. 34,810 patients born between 1945 and 1965 engaged in primary care between October 1, 2014, and October 31, 2016, within the safety-net clinics of the San Francisco Health Network. Rate of hepatitis C testing, hepatitis C treatment, and response to therapy. Cohort characteristics were as follows: median age 59 years, 57.6% male, 25.5% White (20.6% Black, 17.7% Latino, 33.0% Asian/Pacific Islander (API), 2% other), and 32.6% preferred a non-English language. 99.7% had an HCV test (95.4% HCV antibody, 4.3% HCVRNA alone). Among HCV antibody-positive patients (N = 4587), 22.9% were not tested for confirmatory HCVRNA. Among viremic patients (N = 3673), 20.8% initiated HCV therapy, 90.6% achieved sustained virologic response (SVR) and 8.1% did not have a SVR test. HCV screening and treatment were highest in APIs (98.7 and 34.7% respectively; p < 0.001). Blacks had the highest chronic HCV rate (22.2%; p < 0.001). Latinos had the lowest SVR rate (81.3%; p = 0.01). On multivariable analysis, API race (vs White, OR 1.20; p = 0.001), presence of HIV co-infection (OR 1.58; p = 0.02), presence of chronic kidney disease (OR 0.47; p < 0.001), English (vs non-English) as preferred language (OR 0.54; p = 0.002), ALT (OR 0.39 per doubling; p < 0.001), and HCVRNA (OR 0.83 per 10-fold increase; p < 0.001) were associated with HCV treatment. Despite near-universal screening, gaps in active HCV confirmation, treatment, and verification of cure were identified and influenced by race. Tailored interventions to engage and treat diverse and underserved populations with HCV infection are needed.
Sections du résumé
BACKGROUND
Birth cohort screening is recommended for hepatitis C virus (HCV) and underserved populations are disproportionally affected by HCV. Little is known about the influence of race on the HCV care continuum in this population.
OBJECTIVE
To assess the cascade of HCV care in a large racially diverse and underserved birth cohort.
DESIGN
Retrospective cohort study using electronic medical record data abstracted until August 31, 2017.
PATIENTS
34,810 patients born between 1945 and 1965 engaged in primary care between October 1, 2014, and October 31, 2016, within the safety-net clinics of the San Francisco Health Network.
MAIN MEASURES
Rate of hepatitis C testing, hepatitis C treatment, and response to therapy.
RESULTS
Cohort characteristics were as follows: median age 59 years, 57.6% male, 25.5% White (20.6% Black, 17.7% Latino, 33.0% Asian/Pacific Islander (API), 2% other), and 32.6% preferred a non-English language. 99.7% had an HCV test (95.4% HCV antibody, 4.3% HCVRNA alone). Among HCV antibody-positive patients (N = 4587), 22.9% were not tested for confirmatory HCVRNA. Among viremic patients (N = 3673), 20.8% initiated HCV therapy, 90.6% achieved sustained virologic response (SVR) and 8.1% did not have a SVR test. HCV screening and treatment were highest in APIs (98.7 and 34.7% respectively; p < 0.001). Blacks had the highest chronic HCV rate (22.2%; p < 0.001). Latinos had the lowest SVR rate (81.3%; p = 0.01). On multivariable analysis, API race (vs White, OR 1.20; p = 0.001), presence of HIV co-infection (OR 1.58; p = 0.02), presence of chronic kidney disease (OR 0.47; p < 0.001), English (vs non-English) as preferred language (OR 0.54; p = 0.002), ALT (OR 0.39 per doubling; p < 0.001), and HCVRNA (OR 0.83 per 10-fold increase; p < 0.001) were associated with HCV treatment.
CONCLUSIONS
Despite near-universal screening, gaps in active HCV confirmation, treatment, and verification of cure were identified and influenced by race. Tailored interventions to engage and treat diverse and underserved populations with HCV infection are needed.
Identifiants
pubmed: 30238404
doi: 10.1007/s11606-018-4649-6
pii: 10.1007/s11606-018-4649-6
pmc: PMC6816604
doi:
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2005-2013Subventions
Organisme : NIAAA NIH HHS
ID : K24 AA022523
Pays : United States
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