HCV Testing and Treatment in a National Sample of US Federally Qualified Health Centers during the Opioid Epidemic.
health centers
hepatitis C
testing
treatment
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:
05 2020
05 2020
Historique:
received:
19
06
2019
accepted:
03
02
2020
pubmed:
7
3
2020
medline:
15
5
2021
entrez:
6
3
2020
Statut:
ppublish
Résumé
Federally qualified health centers (FQHCs) serve diverse communities in the United States (U.S.) and could function as important venues to diagnose and treat hepatitis C virus (HCV) infections. To determine HCV testing proportion and factors associated with treatment initiation, and treatment outcomes in a large sample of FQHCs around the U.S. Retrospective cohort study using electronic health records of three hundred and forty-one FQHC clinical sites participating in the OCHIN network in 19 U.S. states. Adult patients (≥ 18 years of age) seen between January 01, 2012, and June 30, 2017. HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 6 months after treatment initiation. Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8694 (9.8%) of individuals tested had reactive results. Of the 6357 with HCV RNA testing, 4092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 87% reached SVR. Having commercial insurance (aOR, 2.11; 95% CI, 1.46-3.05), older age (aOR, 1.07; 95% CI, 1.06-1.09), and being Hispanic/Latino (aOR, 1.87; 95% CI, 1.38-2.53) or Asian/Pacific Islander (aOR, 2.47; 95% CI, 1.46-4.19) were independently associated with higher odds of treatment initiation after multivariable adjustment. In contrast, women (aOR, 0.76; 95% CI, 0.60-0.97) and the uninsured (aOR, 0.15; 95% CI, 0.09-0.25) were less likely to initiate treatment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV. Fewer than 20% of individuals with identified OUD were tested for HCV. SVR was lower than findings in other real-world cohorts. Measures to improve outcomes should be considered with the expansion of HCV management into community clinics.
Sections du résumé
BACKGROUND
Federally qualified health centers (FQHCs) serve diverse communities in the United States (U.S.) and could function as important venues to diagnose and treat hepatitis C virus (HCV) infections.
OBJECTIVE
To determine HCV testing proportion and factors associated with treatment initiation, and treatment outcomes in a large sample of FQHCs around the U.S.
DESIGN
Retrospective cohort study using electronic health records of three hundred and forty-one FQHC clinical sites participating in the OCHIN network in 19 U.S. states.
PARTICIPANTS
Adult patients (≥ 18 years of age) seen between January 01, 2012, and June 30, 2017.
MAIN MEASURES
HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 6 months after treatment initiation.
KEY RESULTS
Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8694 (9.8%) of individuals tested had reactive results. Of the 6357 with HCV RNA testing, 4092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 87% reached SVR. Having commercial insurance (aOR, 2.11; 95% CI, 1.46-3.05), older age (aOR, 1.07; 95% CI, 1.06-1.09), and being Hispanic/Latino (aOR, 1.87; 95% CI, 1.38-2.53) or Asian/Pacific Islander (aOR, 2.47; 95% CI, 1.46-4.19) were independently associated with higher odds of treatment initiation after multivariable adjustment. In contrast, women (aOR, 0.76; 95% CI, 0.60-0.97) and the uninsured (aOR, 0.15; 95% CI, 0.09-0.25) were less likely to initiate treatment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV.
CONCLUSIONS
Fewer than 20% of individuals with identified OUD were tested for HCV. SVR was lower than findings in other real-world cohorts. Measures to improve outcomes should be considered with the expansion of HCV management into community clinics.
Identifiants
pubmed: 32133577
doi: 10.1007/s11606-020-05701-9
pii: 10.1007/s11606-020-05701-9
pmc: PMC7210368
doi:
Substances chimiques
Analgesics, Opioid
0
Antiviral Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1477-1483Subventions
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Organisme : NCHHSTP CDC HHS
ID : U38 PS004644
Pays : United States
Organisme : NIAID NIH HHS
ID : P30AI042853
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA044085
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI042853
Pays : United States
Organisme : NCHHSTP CDC HHS
ID : NU38PS004644
Pays : United States
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