A study found variations in treatment initiation, especially showing differences within certain populations, ages, and those with a background of injection drug use.
In a large retrospective cohort study, investigators found hepatitis C (HCV) treatment initiation was low among Medicaid beneficiaries overall and varied by demographic characteristics and comorbidities.
The study’s findings were published in JAMA Network Open.
Specifically, the investigators saw there was a significant difference of lower treatment initiation in people younger than 30 years old, females, Hispanic and Asian individuals, and people who inject drugs (PWID).
Conversely, people who initiated HCV treatment were more frequently older and male.
“Of 161 623 patients with an HCV diagnosis during the study period, 87 652 were included in the final analysis. Of the included patients, 43 078 (49%) were females, 12 355 (14%) were age 18 to 29 years, 35 181 (40%) were age 30 to 49 years, 51 282 (46%) were non-Hispanic White, and 48 840 (49%) had an IDU [injection drug use] diagnosis. Additionally, 17 927 patients (20%) received HCV treatment within 6 months of their HCV diagnosis,” the investigators wrote.
For the study, the primary outcome was initiation of direct-acting antiviral (DAA) treatment for those diagnosed with HCV. DAAs are the first line of therapy, and the investigators looked at filled prescriptions for DAAs up to 6 months after the date of diagnosis. They said they chose a short interval for 3 reasons: including treatment is recommended for everyone at time of diagnosis; the case definition requires a test followed by an ICD diagnostic code, already accounts for the lag time between testing, diagnosis, and awareness of the diagnosis; and they said this mitigates the amount of sample attrition associated with Medicaid disenrollment.
The investigators examined Medicaid claims from 2017 to 2019 from 50 states, Washington DC, and Puerto Rico. People included in the study were ages 18 to 64 years with a new hepatitis C diagnosis.
DDA therapy can provide curative treatment of HCV, but remains underutilized. This study points to specific populations and people with a specific comorbidity (IDU) that public health officials and clinicians can target for educational programs to increase treatment uptake.
“Treatment initiation was significantly lower among younger individuals. Likewise, treatment was lower among people who had diagnoses or treatments suggestive of IDU. Young PWID are a priority population for elimination programming due to several barriers to treatment, including low perceived severity of HCV, its long asymptomatic period, decreased engagement with health care, stigma, socioeconomic instability, and policies that restrict treatment coverage to those with severe disease or documented sobriety.”
“These findings suggest that interventions are needed to increase treatment rates for hepatitis C overall and among key populations and ensure equity in treatment within the Medicaid program,” the investigators wrote.