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Erschienen in:
04.03.2020 | Original Research
HCV Testing and Treatment in a National Sample of US Federally Qualified Health Centers during the Opioid Epidemic
Erschienen in: Journal of General Internal Medicine | Ausgabe 5/2020
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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.