Direct-acting anti-virals are safe, effective treatment of hepatitis C virus (HCV).
Suboptimal linkage to specialists and access to direct-acting anti-virals are the leading barriers to treatment.
However, data are limited.
Dr Kanwal and colleagues from Texas, USA determined predictors of follow-up, receipt of direct-acting anti-virals, and reasons for the lack thereof.
The research team used clinical data from retrospective cohort of HCV-infected patients with previously established HCV care in the US Department of Veterans Affairs to examine predictors of follow-up in HCV clinics and direct-acting anti-viral treatment.
The researchers then conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow-up and treatment.
|28% received direct-acting anti-virals|
|Alimentary Pharmacology & Therapeutics|
The team identified 84 221 veterans who were previously seen in HCV clinics during the pre-direct-acting anti-virals era.
Of these, 56% were followed-up in HCV specialty clinics, 29% of whom received direct-acting anti-virals.
Older age, prior treatment, presence of cirrhosis or HCC, HIV/HBV co-infection and psychiatric illness were predictors of follow-up.
The research team found that alcohol/drug abuse and medical co-morbidity were predictors of lack of treatment.
Of the 905 prospectively recruited patients, 56% of patients had a specialist visit and 28% received direct-acting anti-virals.
The team observed that common reasons for lack of follow-up were relocation, and missed/cancelled appointments.
Reasons for lack of treatment included waiting for newer therapy, co-morbidities and alcohol/drug abuse.
Dr Kanwal's team concludes, "Half of patients with established HCV care were followed-up in the direct-acting anti-viral era and only 29% received direct-acting anti-virals."
"Targeted efforts focusing on patient and system-levels may improve the reach of treatment with the new direct-acting anti-virals."