Journal Article

Predictors of hepatitis C treatment outcomes in a harm reduction-focused primary care program in New York City

Vu, Trang, Riazi, Farah, Oster, Scott, Weiss, Jeffrey, Sigel, Keith, Ziff, Jacob, Toribio, Wilma, Dvir, Danielle

2021

Overview

Background The social determinants of health that influence steps in the entire Hepatitis C Virus (HCV) treatment cascade must be identified to achieve HCV elimination goals. This project aimed to evaluate the association of these factors with HCV treatment completion and return for sustained virologic response (SVR) testing. Methods We used retrospective cohort data from our primary care-based HCV treatment program that provides comprehensive harm reduction care to those who use or formerly used drugs. Among persons who began direct-acting antiviral HCV treatment between December 2014 and March 2018, we identified two outcomes: HCV treatment completion and return for SVR assessment 12 weeks after treatment end. Several predictors were ascertained including sociodemographic information, substance use, psychiatric symptoms and history, housing instability, and HCV treatment regimen. We then evaluated associations between predictors and outcomes using univariate and multivariable statistical methods. Results From a cohort of 329 patients treated in an urban primary care center, multivariable analysis identified housing instability as a single significant predictor for HCV treatment completion (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.1–0.9). Among patients completing treatment, 226 (75%) returned for SVR assessment; the sole predictor of this outcome was Medicaid as primary insurance (compared to other insurances; OR 0.3; 0.1–0.7). Conclusions Innovative strategies to help unstably housed persons complete HCV treatment are urgently needed in order to reach HCV elimination targets. Educational and motivational strategies should be developed to promote individuals with Medicaid in particular to return for SVR viral load testing, a critical post-treatment component of the HCV treatment cascade. Trial registration Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Antiviral agents / Antiviral drugs / Biopsy / Care and treatment / Confidence intervals / Direct-acting antiviral / Drug use / Evaluation / Harm reduction / Health care / Health care access / Health Promotion and Disease Prevention / Health Psychology / Hepatitis / Hepatitis C / Housing / Imprisonment / Infections / Liver / Medicaid / Medical records / Medical screening / Medicine / Medicine & Public Health / Mental disorders / Mental health care / Patient outcomes / Patients / People who inject drugs / Primary care / Primary health care / Prognosis / Reduction / Retention / Social determinants of health / Social Policy / Social Work / Stability analysis / Statistical analysis / Statistical methods / Substance use / Underserved populations / Unstable housing