medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2015, Number 2

<< Back Next >>

Ann Hepatol 2015; 14 (2)

Reasons for HCV non-treatment in underserved African Americans: Implications for treatment with new therapeutics

Schaeffer S, Khalili M

Language: English
References: 24
Page: 234-242
PDF size: 106.95 Kb.


ABSTRACT

Background. African Americans are disproportionately affected by hepatitis C (HCV) and are less likely to undergo HCV treatment. Underserved populations are especially at risk for experiencing health disparity. Aim. To identify reasons for HCV non-treatment among underserved African Americans in a large safetynet system. Material and methods. Medical records of HCV-infected African Americans evaluated at San Francisco General Hospital liver specialty clinic from 2006-2011 who did not receive HCV treatment were reviewed. Treatment eligibility and reasons for non-treatment were assessed. Factors associated with treatment ineligibility were assessed using logistic regression modeling. Results. Among 118 patients, 42% were treatment ineligible, 18% treatment eligible, and 40% were undergoing work-up to determine eligibility. Reasons for treatment ineligibility were medical (54%), non-medical (14%), psychiatric (4%), or combined (28%). When controlling for age and sex, active/recent substance abuse (OR 6.65, p = 0.001) and having two or more medical comorbidities (OR 3.39, p = 0.005) predicted treatment ineligibility. Excluding those ineligible for treatment, 72% of all other patients were lost to follow-up; they were older (55 vs. 48 years, p = 0.01) and more likely to be undergoing work up to determine treatment eligibility (86 vs. 21%, p ‹ 0.0001) than those not lost to follow-up. Conclusions. Medical comorbidities and substance abuse predicted HCV treatment ineligibility in underserved African Americans. Importantly, the majority of those undergoing work-up to determine HCV treatment eligibility were lost to follow-up. While newer anti-HCV agents may increase treatment eligibility, culturally appropriate interventions to increase compliance with evaluation and care remain critical to HCV management in underserved African Americans.


REFERENCES

  1. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006; 144: 705-14.

  2. Daniel S. Chronic hepatitis C treatment patterns in African American patients: An update. Am J Gastroenterol 2005; 100: 716-22.

  3. Crosse K, Umeadi OG, Anania FA, Laurin J, Papadimitriou J, Drachenberg C, Howell CD. Racial differences in liver inflammation and fibrosis related to chronic hepatitis C. Clin Gastroenterol Hepatol 2004; 2: 463-8.

  4. Howell C, Jeffers L, Hoofnagle JH. Hepatitis C in African Americans: Summary of a workshop. Gastroenterology 2000; 119: 1385-96.

  5. Khokhar OS, Lewis JH. Reasons why patients infected with chronic hepatitis C virus choose to defer treatment: Do they alter their decision with time? Dig Dis Sci 2007; 52: 1168-76.

  6. Borum ML, Igiehon E, Shafa S. African Americans may differ in their reasons for declining hepatitis C therapy compared to non-African Americans. Dig Dis Sci 2009; 54: 1604; author reply 1604-05.

  7. Melia MT, Muir AJ, McCone J, Shiffman ML, King JW, Herrine SK, Galler GW, et al. Racial differences in hepatitis C treatment eligibility. Hepatology 2011; 54: 70-8.

  8. Hare CB, Morris JA, Chu A, Gotz V, Loveland JJ, Hodes D, Klaskala W. Comparison of characteristics of treated and non-treated patients with hepatitis C infection. Pharmacoepidemiol Drug Saf 2006; 15: 71-6.

  9. Lawitz E, Gane EJ. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 2013; 369: 678-9.

  10. Cheung RC, Currie S, Shen H, Ho SB, Bini EJ, Anand BS, Bräu N, et al. Chronic hepatitis C in Latinos: Natural history, treatment eligibility, acceptance, and outcomes. Am J Gastroenterol 2005; 100: 2186-93.

  11. Srivastava S, Bertagnolli M, Lewis JH. Sustained virological response rate to pegylated interferon plus ribavirin for chronic hepatitis C in African Americans: Results in treatment- naïve patients in a university liver clinic. J Natl Med Assoc 2005; 97: 1703-07.

  12. Schackman BR, Teixeira PA, Beeder AB. Offers of hepatitis C care do not lead to treatment. J Urban Health 2007; 84: 455-58.

  13. Butt AA, Wagener M, Shakil AO, Ahmad J. Reasons for nontreatment of hepatitis C in veterans in care. J Viral Hepat 2005; 12: 81-5.

  14. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, et al. Heart disease and stroke statistics—2013 update: A report from the American Heart Association. Circulation 2013; 127: e6-e245.

  15. Jacobson IM, McHutchison JG, Dusheiko G, Di Bisceglie AM, Reddy KR, Bzowej NH, Marcellin P, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med 2011; 364: 2405-16.

  16. Guy J, Yee HF. Health disparities in liver disease: Time to take notice and take action. Hepatology 2009; 50: 309-13.

  17. Surjadi M, Torruellas C, Ayala C, Yee HF, Khalili M. Formal patient education improves patient knowledge of hepatitis C in vulnerable populations. Dig Dis Sci 2011; 56: 213-9.

  18. Lubega S, Agbim U, Surjadi M, Mahoney M, Khalili M. Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response. Liver Int 2013; 33: 999-1007.

  19. Bindman AB, Chen A, Fraser JS, Yee HF, Ofman D. Healthcare reform with a safety net: Lessons from San Francisco. Am J Manag Care 2009; 15: 747-50.

  20. Institute of Medicine. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: National Academies Press; 2010.

  21. Centers for Disease Control and Prevention. Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; October 2010. Available at: www.cdc.gov/socialdeterminants. Accessed November 11, 2013.

  22. U.S. Department of Health and Human Services. Combating the silent epidemic of viral hepatitis: Action plan for the prevention, care, and treatment of viral hepatitis (2014- 2016). Available at: http://aids.gov/pdf/viral-hepatitisaction- plan.pdf. Accessed July 1st, 2014.

  23. San Francisco General Hospital and Trauma Center annual report, fiscal year 2012-13. Available at: http://www.sfdph.org/dph/files/SFGHdocs/2012- 2013AnnualReport131031.pdf. Accessed on November 1st, 2013.

  24. Clark PJ, Muir AJ. Overcoming barriers to care for hepatitis C. N Engl J Med 2012; 366: 2436-8.




2020     |     www.medigraphic.com