Disparities in Antiviral Treatment for HCV Lead to Prolonged Infection

New research has found low rates of direct-acting antiviral (DAA) treatment initiation for hepatitis C virus (HCV) among individuals who inject drugs, suggesting that policies should be enacted to reduce disparities.

The hepatitis C virus (HCV) infection is a public health problem in the United States, as the infection rate has doubled from 2013 to 2020. Research has shown that the United States will not be able to successfully cure HCV by the year of 2030. However, direct-acting antiviral (DAA) medications are a form of treatment that provides a therapeutic advancement.

The study authors note that this question was raised because 55% of people who inject drugs (PWID) are Medicaid beneficiaries. Although each state varies with disparities and treatment access for HCV, some Medicaid programs have required proof of sobriety, liver disease, or a consultation with a specialist before receiving DAA treatment. If the treatment is not covered by insurance, many individuals will not have access—prolonging the infection of HCV.

“We examined disparities in the 6-month initiation of HCV treatment among Medicaid beneficiaries newly diagnosed with HCV. We chose this population to reflect incident HCV diagnoses, thus reflecting current and future disparities patterns, and chose a short-term outcome because of the importance of rapid treatment as a goal to prevent HCV transmission,” said the study authors.

The researchers directed a retrospective cohort study of 87,652 US Medicaid enrollees who resided in 47 states, Washington D.C, and Puerto Rico and were between the ages of 18 and 64 years. The requirements included a Current Procedural Terminology (CPT), which is an HCV RNA test, along with International Statistical Classification of Disease and related Health Problems, Tenth Revision (ICD-10), which is HCV within 180 days.

Age, sex, and race and ethnicity were collected in the data, the study authors noted. The researchers acknowledged that individuals of diverse racial and ethnic groups could have different access to HCV treatment.

Out of the 87,652 individuals in the study, 49% were females, 40% were ages 30 to 49 years, 46% were non-Hispanic, and 49% had an injection drug user (IDU) diagnosis. Only 20% of individuals received an HCV treatment within the first 6 months of their HCV diagnosis. Out of these 17,927 individuals, the majority were older males who were less likely to have IDU.

The study authors noted that among those who received a DAA treatment, most were male, and the least were younger individuals, individuals with IDU, and females. There was also a higher chance for non-Hispanic white individuals to receive treatment, compared to Asian individuals.

“The overall rate of treatment initiation is low. Because HCV treatment supports HCV prevention by reducing risk of transmission, these findings may have dire consequences for HCV elimination planning, which relies on achieving high treatment rates.” said the study authors.

The findings suggest that policy efforts must be put in place to support HCV treatment for all individuals to reduce the disparities of DAA treatment.

Reference:

Hepatitis C Treatment Initiation Among US Medicaid Enrollees. Jama Network. News release. August 4, 2023. Accessed August 9, 2023. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808080.