Uptake of and factors associated with direct-acting anti-viral therapy among patients infected with hepatitis C virus in the Chronic Hepatitis Cohort Study, 2014-2015

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Background: Limited information is available describing the uptake of direct acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection among patients in general US healthcare settings. Methods: We analyzed data collected from HCV-infected patients in the Chronic Hepatitis Cohort Study (CHeCS), an observational cohort study involving patients from health-care organizations in Michigan, Pennsylvania, Oregon, and Hawaii, limiting analysis to patients with a clinical encounter during the previous two years. Uptake was defined as the proportion of patients infected with HCV as of December 31, 2013 who were prescribed a DAA regimen (with or without interferon) during 2014 and started the regimen by August 31, 2015. Using multivariable analysis and controlling for relevant variables, we examined demographic and clinical characteristics associated with receipt of DAAs. Results: The cohort was comprised of 10,293 HCV-infected patients as of December 31, 2013, of whom 544 (5.3%) started a DAA regimen by August 31, 2015. Factors independently associated with receipt of DAAs included higher annual income (adjusted Odds Ratios [aOR] 2.4 and 1.7 for income >$50K and $30K-$50K, respectively, vs. <$30K), higher FIB4 score (aORs 2.1, 2.0, and 1.5 for FIB4 >5.88, 3.25-5.88, 2.0-<3.25, respectively, vs. <2.0), genotype 2 infection (aOR 2.2, vs. genotype 1), higher Charlson comorbidity score (aORs 1.3 and 1.4 for scores ≥2 and 1, respectively, vs. score of 0), pre-2014 treatment failure (aOR 1.9, vs. treatment-naive), and HIV coinfection (aOR 1.9, vs. HCV monoinfection). Factors associated with a reduced likelihood of DAA receipt included non-Hispanic Black race/ethnicity (aOR 0.7, vs. non-Hispanic Whites), having Medicaid coverage (aOR 0.5, vs. private insurance), and receipt of care at one of the study sites (aOR 0.3, vs. atertiary hepatology referral site). Sex, age, and duration of follow-up were not associated with receipt of DAAs. Conclusions:Among patients in these general US healthcare settings, uptake of DAA therapy was low from January 2014-August 2015,and especially so among minority and Medicaid patients. Targeted efforts to improve access to DAAs for these patients areessential to reduce morbidity and mortality from HCV infection.




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