Conar R O'Neil1, Emily Buss2, Sabrina Plitt2,3, Mariam Osman2,4, Carla S Coffin5, Carmen L Charlton6,7, Stephen Shafran8. 1. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. conar@ualberta.ca. 2. School of Public Health, University of Alberta, Edmonton, Alberta, Canada. 3. Centre for Communicable Disease and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada. 4. Alberta Health, Edmonton, Alberta, Canada. 5. Calgary Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada. 6. Provincial Laboratory for Public Health, Edmonton, Alberta, Canada. 7. Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. 8. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Abstract
OBJECTIVES: Despite highly effective directly acting antiviral (DAA) therapy for hepatitis C virus (HCV), many patients do not receive treatment. We characterized the achievement of cascade of care milestones within 2 years of diagnosis among the Alberta population and evaluated variables associated with engagement at each stage. METHODS: All Albertans with a first-time positive HCV antibody between 2009 and 2014 were included in this retrospective study. We determined which patients received follow-up testing (HCV RNA and HCV genotype), referral to hepatitis specialty care, and antiviral prescription, and achieved SVR within 2 years of diagnosis. Factors associated with achieving cascade milestones were identified by multivariable logistic regression analysis. RESULTS: Of 6154 patients with HCV antibody and complete follow-up, 4238 (68.9%) had HCV RNA testing, 2360 (38.3%) had HCV genotyping, 2096 (34.1%) were assessed by a specialist, 711 (11.6%) were prescribed treatment and 207 (3.4%) achieved SVR within 2 years of diagnosis. Independent variables associated with reduced likelihood of achieving cascade milestones were Indigenous heritage (adjusted odds ratio (AOR) 0.53 (0.41-0.68) for HCV RNA testing), unstable housing (AOR 0.50 (0.32-0.79) for specialist assessment) and alcohol misuse (AOR 0.61 (0.38-0.99) for antiviral prescription). Men, older patients, patients with a higher income and patients with more advanced liver disease were more likely to achieve cascade of care milestones. CONCLUSION: At each stage of patient engagement, opportunities for improvement were identified. Understanding the local cascade of care and factors associated with achieving cascade milestones will help prioritize initiatives to facilitate access to DAA therapy in Alberta.
OBJECTIVES: Despite highly effective directly acting antiviral (DAA) therapy for hepatitis C virus (HCV), many patients do not receive treatment. We characterized the achievement of cascade of care milestones within 2 years of diagnosis among the Alberta population and evaluated variables associated with engagement at each stage. METHODS: All Albertans with a first-time positive HCV antibody between 2009 and 2014 were included in this retrospective study. We determined which patients received follow-up testing (HCV RNA and HCV genotype), referral to hepatitis specialty care, and antiviral prescription, and achieved SVR within 2 years of diagnosis. Factors associated with achieving cascade milestones were identified by multivariable logistic regression analysis. RESULTS: Of 6154 patients with HCV antibody and complete follow-up, 4238 (68.9%) had HCV RNA testing, 2360 (38.3%) had HCV genotyping, 2096 (34.1%) were assessed by a specialist, 711 (11.6%) were prescribed treatment and 207 (3.4%) achieved SVR within 2 years of diagnosis. Independent variables associated with reduced likelihood of achieving cascade milestones were Indigenous heritage (adjusted odds ratio (AOR) 0.53 (0.41-0.68) for HCV RNA testing), unstable housing (AOR 0.50 (0.32-0.79) for specialist assessment) and alcohol misuse (AOR 0.61 (0.38-0.99) for antiviral prescription). Men, older patients, patients with a higher income and patients with more advanced liver disease were more likely to achieve cascade of care milestones. CONCLUSION: At each stage of patient engagement, opportunities for improvement were identified. Understanding the local cascade of care and factors associated with achieving cascade milestones will help prioritize initiatives to facilitate access to DAA therapy in Alberta.
Entities:
Keywords:
Canada; Delivery of health care; Hepatitis C; Vulnerable populations
Authors: Robert P Myers; Mel Krajden; Marc Bilodeau; Kelly Kaita; Paul Marotta; Kevork Peltekian; Alnoor Ramji; Chris Estes; Homie Razavi; Morris Sherman Journal: Can J Gastroenterol Hepatol Date: 2014-05
Authors: Oluwaseun Falade-Nwulia; Catalina Suarez-Cuervo; David R Nelson; Michael W Fried; Jodi B Segal; Mark S Sulkowski Journal: Ann Intern Med Date: 2017-03-21 Impact factor: 25.391
Authors: Brian J Mcmahon; Lisa Townshend-Bulson; Chriss Homan; Prabhu Gounder; Youssef Barbour; Annette Hewitt; Dana Bruden; Hannah Espera; Julia Plotnik; James Gove; Timothy J Stevenson; Sarah V Luna; Brenna C Simons Journal: Clin Infect Dis Date: 2020-04-15 Impact factor: 9.079
Authors: Dena P Blanding; William P Moran; John Bian; Jingwen Zhang; Justin Marsden; Patrick D Mauldin; Don C Rockey; Andrew D Schreiner Journal: J Investig Med Date: 2020-11-17 Impact factor: 2.895