Increasing success and evolving barriers in the hepatitis C cascade of care during the direct acting antiviral era
Barriers remain in the hepatitis C virus (HCV) cascade of care (CoC), limiting the overall impact of direct acting antivirals. This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real wo...
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| Veröffentlicht in: | PloS one 2018-06, Vol.13 (6), p.e0199174-e0199174 |
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| creator | Zuckerman, Autumn Douglas, Andrew Nwosu, Sam Choi, Leena Chastain, Cody |
| description | Barriers remain in the hepatitis C virus (HCV) cascade of care (CoC), limiting the overall impact of direct acting antivirals. This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real world population. We performed a single-center, ambispective cohort study of patients receiving care in an outpatient infectious diseases clinic between October 2015 and September 2016. Patients were followed from treatment referral through sustained virologic response. Univariate and multivariate analyses were performed to identify factors related to completion of each step of the CoC. Of 187 patients meeting inclusion criteria, 120 (64%) completed an evaluation for HCV treatment, 119 (64%) were prescribed treatment, 114 (61%) were approved for treatment, 113 (60%) initiated treatment, 107 (57%) completed treatment, and 100 (53%) achieved a sustained virologic response. In univariate and multivariate analyses, patients with Medicaid insurance were less likely to complete an evaluation and were less likely to be approved for treatment. Treatment completion and SVR rates are much improved from historical CoC reports. However, linkage to care following referral continues to be a formidable challenge for the HCV CoC in the DAA era. Ongoing efforts should focus on linkage to care to capitalize on DAA treatment advances and improving access for patients with Medicaid insurance. |
| doi_str_mv | 10.1371/journal.pone.0199174 |
| format | Article |
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This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real world population. We performed a single-center, ambispective cohort study of patients receiving care in an outpatient infectious diseases clinic between October 2015 and September 2016. Patients were followed from treatment referral through sustained virologic response. Univariate and multivariate analyses were performed to identify factors related to completion of each step of the CoC. Of 187 patients meeting inclusion criteria, 120 (64%) completed an evaluation for HCV treatment, 119 (64%) were prescribed treatment, 114 (61%) were approved for treatment, 113 (60%) initiated treatment, 107 (57%) completed treatment, and 100 (53%) achieved a sustained virologic response. In univariate and multivariate analyses, patients with Medicaid insurance were less likely to complete an evaluation and were less likely to be approved for treatment. Treatment completion and SVR rates are much improved from historical CoC reports. However, linkage to care following referral continues to be a formidable challenge for the HCV CoC in the DAA era. Ongoing efforts should focus on linkage to care to capitalize on DAA treatment advances and improving access for patients with Medicaid insurance.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0199174</identifier><identifier>PMID: 29912944</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Antiviral agents ; Antiviral Agents - therapeutic use ; Antiviral drugs ; Biology and life sciences ; Care and treatment ; Continuity of Patient Care ; Continuum of care ; Critical Pathways ; Dosage and administration ; Engineering and Technology ; Evaluation ; Female ; Government programs ; Health care ; Health Services Accessibility ; Hepatitis ; Hepatitis C ; Hepatitis C - drug therapy ; Hepatitis C - therapy ; HIV ; Human immunodeficiency virus ; Humans ; Infectious diseases ; Insurance ; Male ; Management ; Medicine and health sciences ; Middle Aged ; Patient compliance ; Patients ; People and Places ; Pharmacists ; Referral and Consultation ; Viruses ; World population</subject><ispartof>PloS one, 2018-06, Vol.13 (6), p.e0199174-e0199174</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Zuckerman et al. 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This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real world population. We performed a single-center, ambispective cohort study of patients receiving care in an outpatient infectious diseases clinic between October 2015 and September 2016. Patients were followed from treatment referral through sustained virologic response. Univariate and multivariate analyses were performed to identify factors related to completion of each step of the CoC. Of 187 patients meeting inclusion criteria, 120 (64%) completed an evaluation for HCV treatment, 119 (64%) were prescribed treatment, 114 (61%) were approved for treatment, 113 (60%) initiated treatment, 107 (57%) completed treatment, and 100 (53%) achieved a sustained virologic response. 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during the direct acting antiviral era</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-06-18</date><risdate>2018</risdate><volume>13</volume><issue>6</issue><spage>e0199174</spage><epage>e0199174</epage><pages>e0199174-e0199174</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Barriers remain in the hepatitis C virus (HCV) cascade of care (CoC), limiting the overall impact of direct acting antivirals. This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real world population. We performed a single-center, ambispective cohort study of patients receiving care in an outpatient infectious diseases clinic between October 2015 and September 2016. Patients were followed from treatment referral through sustained virologic response. Univariate and multivariate analyses were performed to identify factors related to completion of each step of the CoC. Of 187 patients meeting inclusion criteria, 120 (64%) completed an evaluation for HCV treatment, 119 (64%) were prescribed treatment, 114 (61%) were approved for treatment, 113 (60%) initiated treatment, 107 (57%) completed treatment, and 100 (53%) achieved a sustained virologic response. In univariate and multivariate analyses, patients with Medicaid insurance were less likely to complete an evaluation and were less likely to be approved for treatment. Treatment completion and SVR rates are much improved from historical CoC reports. However, linkage to care following referral continues to be a formidable challenge for the HCV CoC in the DAA era. Ongoing efforts should focus on linkage to care to capitalize on DAA treatment advances and improving access for patients with Medicaid insurance.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29912944</pmid><doi>10.1371/journal.pone.0199174</doi><tpages>e0199174</tpages><orcidid>https://orcid.org/0000-0003-1952-0244</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Antiviral agents Antiviral Agents - therapeutic use Antiviral drugs Biology and life sciences Care and treatment Continuity of Patient Care Continuum of care Critical Pathways Dosage and administration Engineering and Technology Evaluation Female Government programs Health care Health Services Accessibility Hepatitis Hepatitis C Hepatitis C - drug therapy Hepatitis C - therapy HIV Human immunodeficiency virus Humans Infectious diseases Insurance Male Management Medicine and health sciences Middle Aged Patient compliance Patients People and Places Pharmacists Referral and Consultation Viruses World population |
| title | Increasing success and evolving barriers in the hepatitis C cascade of care during the direct acting antiviral era |
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