William F. Balistreri, MD


March 17, 2016

In This Article

Linkage to Care

Data from the Centers for Disease Control's Hepatitis Testing and Linkage to Care project were reviewed by Vellozzi and colleagues[12] to document the level of implementation of the one-time HCV testing recommendation for persons born during 1945-1965. Among 24,966 persons in 10 states who were tested at clinics primarily serving under- or uninsured patients, 12% were anti-HCV positive. Among all anti-HCV positive persons, 73% received an HCV RNA test, 71% were currently infected, and 82% were referred to care. Testing was disproportionately low in non-Hispanic black persons compared with non-Hispanic white persons. Nearly 80% of all persons with current HCV infection who were referred to care attended their first appointment.

These findings suggest that birth cohort testing is likely to identify a substantial number of persons living with HCV infection. However, barriers persist early in the care continuum, particularly for non-Hispanic black persons. Additional efforts are needed to ensure confirmatory testing and linkage to care for all persons who are positive for anti-HCV.

Care Within the Veterans Affairs Healthcare System

Backus and colleagues[13] assessed delivery of the critical steps of HCV care (ie, detection, linkage, and treatment) by the Veterans Affairs healthcare system. The majority of more than 5.7 million veterans with HCV were identified and linked to HCV care. However, the investigators identified large gaps in care during the initiation of antiviral treatment.

Denial of Treatment for Hepatitis C

One of the reasons for the failure to initiate treatment for chronic HCV infection in any real-world setting is the high cost of the DAA agents. The high cost has resulted in denials and delays in the receipt of therapy.

Lo Re and colleagues[14] sought to prospectively determine the incidence and determinants of denial of a DAA prescription among patients in the US mid-Atlantic region with chronic HCV infection, according to type of insurance. Among 2350 patients who were prescribed a DAA regimen, 16% received an absolute denial. The most common reasons were insufficient information to assess medical need, lack of medical necessity, and a positive alcohol or drug screen. Prescriptions were more commonly denied for patients covered by Medicaid than by Medicare or commercial insurance. The median time to DAA prescription fill also was longer for patients with Medicaid than with Medicare or commercial insurance.

The authors reported that their data confirm anecdotal reports from physicians that they are unable to provide these antiviral drugs to some of their most impoverished patients.


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