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Wolfe HL, Hughto JMW, Quint M, Hashemi L, Hughes LD. Hepatitis C Virus Testing and Care Cascade Among Transgender and Gender Diverse Individuals. Am J Prev Med 2023; 64:695-703. [PMID: 36759228 PMCID: PMC10121731 DOI: 10.1016/j.amepre.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) prevalence among transgender and gender-diverse individuals ranges from 1.8% to 15.7% versus 1% in the general population. Previous HCV studies inclusive of transgender and gender-diverse individuals primarily rely on convenience-based sampling methods or are geographically restricted. The purpose of this study is to compare the prevalence of HCV diagnoses, testing, and care engagement between transgender and gender-diverse and cisgender individuals. METHODS Using Optum's de-identified Clinformatics® Data Mart Database, in 2022, the unadjusted prevalence of HCV testing among all adults and people who inject drugs from January 2001 to December 2019 was measured. Multivariable logistic regression was used to compare the adjusted odds of HCV diagnoses and care engagement by gender subgroup. RESULTS The overall unadjusted frequency of HCV diagnoses among transgender and gender-diverse individuals was approximately 3 times that of cisgender individuals (1.06% vs 0.38%, p<0.001), including among people who inject drugs (6.36% vs 2.36%, p=0.007). Compared with cisgender women, transfeminine/nonbinary individuals had over 5 times the adjusted odds of a HCV diagnosis and approximately 3.5 times the odds of being tested for HCV. In addition, compared with cisgender women, transfeminine/nonbinary individuals had significantly increased odds of having a HCV‒related procedure (e.g., abdominal ultrasounds, liver biopsies, Fibroscans). Cisgender men had significantly increased odds of receiving HCV medication compared with cisgender women. CONCLUSIONS Although testing was higher among transgender and gender-diverse individuals, the higher overall frequency of HCV diagnoses among transgender and gender-diverse than among cisgender individuals signals persistent health disparities. Interventions are warranted to prevent HCV and increase ongoing testing and treatment uptake among transgender and gender-diverse populations.
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Affiliation(s)
- Hill L Wolfe
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, Massachussetts.
| | - Jaclyn M W Hughto
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, Rhode Island; Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; The Fenway Institute, Fenway Health, Boston, Massachussetts
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachussetts
| | - Leila Hashemi
- Division of Primary Care, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Landon D Hughes
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Nguyen VH, Kam L, Yeo YH, Huang DQ, Henry L, Cheung R, Nguyen MH. Characteristics and Treatment Rate of Patients With Hepatitis C Virus Infection in the Direct-Acting Antiviral Era and During the COVID-19 Pandemic in the United States. JAMA Netw Open 2022; 5:e2245424. [PMID: 36477481 PMCID: PMC9856330 DOI: 10.1001/jamanetworkopen.2022.45424] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Clinical data on hepatitis C virus (HCV) treatment rates in the United States are sparse. OBJECTIVE To evaluate HCV treatment rates in the era of direct-acting antivirals (DAAs). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the deidentified Optum Cliniformatics Data Mart Database (2014-2021) on patients with HCV in the DAA and COVID-19 eras. The database includes patients with private health insurance in the US. MAIN OUTCOMES AND MEASURES The treatment rate and changes over time were assessed with adjusted log-binomial regression, and factors associated with treatment were examined using multivariable logistic regression. RESULTS A total of 133 348 patients with HCV (79 567 [59.7%] men; mean [SD] age, 59.7 [12.3] years; 4448 [3.3%] Asian, 24 662 [18.5%] Black, and 74 750 [56.1%] White individuals) were included; 38 180 (26.8%) had HCV RNA data, and of those, 20 277 (53.1%) had positive HCV RNA. Overall, 13 214 patients with positive HCV RNA tests (65.2%) received DAA treatment; 6456 of 6634 patients treated with DAAs (97.3%) achieved sustained virologic response. After adjusting for age, sex, and race and ethnicity, the treatment rate in 2018 was 0.5 times greater than the rate in 2014 (adjusted prevalence ratio, 1.50; 95% CI, 1.42-1.59) but declined after 2018, decreasing from 64.8% to 61.2%, and especially after 2019, when it decreased to less than 60% (P < .001). The number of patients with viremic HCV identified in between April 2020 and March 2021 also decreased to 496 from 2761 and 3258 in the preceding 2 years. Receiving care from a gastroenterologist or infectious disease specialist with advanced care practitioner (ie, nurse practitioner, physician assistant, or clinical nurse specialist) was independently associated with greater odds of DAA treatment (adjusted odds ratio [aOR], 1.64; 95% CI, 1.07-1.50). Patients with decompensated cirrhosis and/or hepatocellular carcinoma (HCC) were 31% less likely to receive treatment compared with those without (aOR, 0.69; 95% CI, 0.54-0.90). CONCLUSIONS AND RELEVANCE In this cohort study, less than two-thirds of insured patients with viremic HCV received DAA treatment, with declines in both the treatment rate and the number of viremic HCV diagnoses since 2019 and especially during the COVID-19 pandemic. Further efforts are needed to increase HCV diagnosis and treatment, especially for those with cirrhosis and HCC. An urgent call for nationwide actions to improve access to DAA treatment, community outreach programs, and specialists through referral pipelines is needed in the United States to stay on track to meet the World Health Organization goal of reducing the burden of viral hepatitis with the eventual goal to eliminate viral hepatitis.
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Affiliation(s)
- Vy H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Leslie Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
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Zijlstra MK, Fidel Nague K, Louie P, Imas P, Sonnenberg A, Fimmel CJ. Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System. J Public Health Manag Pract 2022; 28:E825-E830. [PMID: 36194824 PMCID: PMC9528933 DOI: 10.1097/phh.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CONTEXT Birth cohort ("baby boomer") screening represents a well-validated strategy for the identification of asymptomatic hepatitis C-infected patients. However, successful linkage of newly diagnosed patients to antiviral therapy has been more difficult to accomplish. OBJECTIVE To analyze the results of a systemwide birth cohort screening program in a US community health care system. DESIGN We analyzed the data from an ongoing hepatitis C virus (HCV) screening and treatment program that was established at NorthShore University Health System in 2015. Hepatitis C virus screening by primary care providers was prompted through automated Best Practice and Health Maintenance alerts. Patient visits and screening orders were tracked using a customized HCV dashboard. Virologic, demographic, and treatment data were assessed and compared with those of a cohort of patients with previously established HCV infection. RESULTS Since program inception, 61 8161 (64.3%) of the entire NorthShore baby boomer population of 96 001 patients have completed HCV antibody testing, and 160 patients (0.26%) were antibody positive. Of 152 antibody-positive patients who underwent HCV RNA testing, 53 (34.2%) were viremic. A total of 39 of 53 patients (73.6%) underwent antiviral therapy and achieved a sustained virologic response. Compared with patients identified through screening, a comparison cohort of patients with previously established HCV had more advanced fibrosis and significantly lower dropout rates. The COVID-19 pandemic was associated with a decrease in the number of outpatient visits of screening-eligible patients and with a reduction in HCV screening rates. CONCLUSION Our data demonstrate the electronic medical records-assisted systemwide implementation of HCV birth cohort screening and successful linkage to antiviral therapy in a community-based US multihospital system.
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Affiliation(s)
- Michael K. Zijlstra
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Kristine Fidel Nague
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Patrick Louie
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Polina Imas
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Amnon Sonnenberg
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Claus J. Fimmel
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
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Ferrante ND, Newcomb CW, Forde KA, Leonard CE, Torgersen J, Linas BP, Rowan SE, Wyles DL, Kostman J, Trooskin SB, Lo Re V. The Hepatitis C Care Cascade During the Direct-Acting Antiviral Era in a United States Commercially-Insured Population. Open Forum Infect Dis 2022; 9:ofac445. [PMID: 36092829 PMCID: PMC9454032 DOI: 10.1093/ofid/ofac445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/30/2022] [Indexed: 12/09/2022] Open
Abstract
Background Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress toward HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct-acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and that 16% had been prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States. Methods We performed a cross-sectional study to describe the HCV care cascade in the United States using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: (1) recorded diagnosis of HCV infection, (2) recorded HCV diagnosis and underwent HCV RNA testing, (3) DAA treatment dispensed, and (4) assessment for cure. Results Among 120,311 individuals estimated to have HCV viremia in Optum during the study period, 109,233 (90.8%; 95% CI, 90.6%–91.0%) had a recorded diagnosis of HCV infection, 75,549 (62.8%; 95% CI, 62.5%–63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41,102 (34.2%; 95% CI, 33.9%–34.4%) were dispensed DAA treatment, and 25,760 (21.4%; 95% CI, 21.2%–21.6%) were assessed for cure. Conclusions Gaps remain between the delivery of HCV-related care and national treatment goals among commercially insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals.
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Affiliation(s)
- Nicole D Ferrante
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Craig W Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Kimberly A Forde
- Section of Hepatology, Department of Medicine, Temple University , Philadelphia, PA , USA
| | - Charles E Leonard
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania , USA
| | - Jessie Torgersen
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine University of Pennsylvania , Philadelphia, PA , USA
| | - Benjamin P Linas
- Division of Infectious Diseases, Boston Medical Center, Boston University School of Medicine , Boston, MA , USA
| | - Sarah E Rowan
- Division of Infectious Diseases, Denver Health Medical Center, University of Colorado School of Medicine , Denver, CO , USA
| | - David L Wyles
- Division of Infectious Diseases, Denver Health Medical Center, University of Colorado School of Medicine , Denver, CO , USA
| | - Jay Kostman
- Philadelphia FIGHT Community Health Centers , Philadelphia, PA , USA
| | - Stacey B Trooskin
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine University of Pennsylvania , Philadelphia, PA , USA
- Philadelphia FIGHT Community Health Centers , Philadelphia, PA , USA
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine University of Pennsylvania , Philadelphia, PA , USA
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Harless C, Lugo B, Ostrach B. Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff. South Med J 2022; 115:422-428. [PMID: 35777748 DOI: 10.14423/smj.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South. METHODS To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders. RESULTS Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV. CONCLUSIONS This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.
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Affiliation(s)
- Chase Harless
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, and Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Brunilda Lugo
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, and Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Bayla Ostrach
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, and Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
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