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Abstract Details
Is the Availability of Direct-Acting Antivirals Associated with Increased Access to Hepatitis C Treatment for Homeless and Unstably Housed Veterans?
J Gen Intern Med. 2021 Jun 25. doi: 10.1007/s11606-021-06933-z. Online ahead of print.
D Keith McInnes12, Lara K Troszak34, B Graeme Fincke56, Michael Shwartz7, Amanda M Midboe34, Allen L Gifford78, Shawn Dunlap5, Thomas Byrne59
Author information
1Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA. donald.mcinnes@va.gov.
2Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, Boston, USA. donald.mcinnes@va.gov.
3Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.
4Stanford University School of Medicine, CA, Stanford, USA.
5Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.
6Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, Boston, USA.
7Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
8Departments of Medicine, and Health Law, Policy, and Management, Boston University Schools of Medicine and Public Health, Boston, MA, USA.
9Boston University School of Social Work, Boston, MA, USA.
Abstract
Objective: Hepatitis C virus (HCV) treatment has experienced a rapid transformation in the USA. New direct-acting antiviral (DAA) medications make treatment easier, less toxic, and more successful (90% or greater viral cure) than prior, interferon-based HCV medications. We sought to determine whether DAAs may have improved access to HCV treatment for hard-to-reach populations such as the homeless.
Methods: In a retrospective study of VA electronic medical record data, a cohort was created of 63,586 veterans with a positive HCV RNA or genotype test taken at any point from January 1, 2012, through December 31, 2016. Patient data were examined for up to 5 years using a discrete time survival model to assess the relationship between their housing status and receipt of HCV medications in 6-month time periods in both the interferon and DAA eras.
Results: In the interferon era, the probability of HCV treatment in a given 6-month window among housed veterans, at 6.2% (95% CI: 5.3-7.1%) was significantly higher than among veterans who were homeless or unstably housed; for example, among currently homeless veterans, the probability of treatment initiation, in a given 6-month window, was 2.6% (95% CI: 1.9-3.3%). With the arrival of DAAs, each housing category had an increased probability of treatment initiation. For housed veterans, the probability was 8.6% (95% CI: 8.3-8.9%) while for currently homeless veterans, it was 6.3% (95% CI: 5.7-6.9%).
Conclusions: We found a clear indication that the likelihood of treatment initiation was greater for all veterans in the DAA era as compared to the interferon era. However, disparities in treatment initiation rates between housed and homeless veterans that were observed in the interferon era persisted in the DAA era.