Author information
1Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA.
2Department of Medicine, University of Washington, Seattle, WA.
3Department of Medicine, Section of Infectious Diseases and International Health, Dartmouth Hitchcock Medical Center, Lebanon, NH.
4College of Public Health, Division of Epidemiology, Ohio State University, Columbus, OH.
5University of Massachusetts Chan Medical School-Baystate, Worcester, MA.
6Baystate Health, 759 Chestnut St, Springfield, MA.
7Department of Pharmacy Practice and Clinical Research, University of Rhode Island, Kingston, RI.
8HealthFirst Family Care Center Inc., Fall River, MA.
9Departments of Behavioral Medicine and Psychiatry & Medicine/Infectious Diseases, West Virginia University School of Medicine, Morgantown, WV.
10Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY.
11Department of Medicine, University of North Carolina, Chapel Hill, NC.
12College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, OR.
13University of Wisconsin, Madison, WI.
14Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY.
15RTI International, Research Triangle Park, NC.
16College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada.
17Department of Medicine, Section of Infectious Diseases & Global Health, University of Chicago, Chicago, IL.
Abstract
Background: Restrictive Medicaid policies regarding hepatitis C virus (HCV) treatment may exacerbate rural health care disparities for people who use drugs (PWUD). We assessed associations between Medicaid restrictions and HCV treatment among rural PWUD.
Methods: We compiled state-specific Medicaid treatment policies across 8 US rural sites in 10 states and merged these with participant survey data. We hypothesized that local restrictions regarding prescriber type, sobriety, and fibrosis estimates were associated with HCV treatment outcomes. We conducted a cross-sectional, ecological analysis of treatment restrictions and HCV treatment outcomes using bivariate analyses to characterize differences between PWUD who initiated HCV treatment and unadjusted logistic regressions to assess associations between restrictions and treatment.
Results: Among 944 participants, 111 (12%) reported receiving HCV treatment. Participants receiving treatment were older [median age (interquartile range): 42 (34-53) vs. 35 (29-42), P<0.001], more likely to receive disability support (32% vs. 20%, P=0.002), and less likely to be Medicaid-insured (57% vs. 71%, P < 0.001). More PWUD in states without any restrictions reported receiving treatment (17% vs. 11%, P=0.08) and achieving HCV cure/clearance (42% vs. 30%, P=0.01) than in states with restrictions. Restrictions were associated with lower odds of receiving HCV treatment (odds ratio=0.61, 95% CI: 0.35-1.06, P=0.08). Sensitivity analyses showed a similar association with HCV cure/clearance (odds ratio=0.60, 95% CI: 0.40-0.91, P=0.02).
Conclusions: We identified significant unadjusted associations between Medicaid restrictions and receipt of HCV treatment and cure, which has substantial implications for health outcomes among rural PWUD. Lifting remaining Medicaid restrictions will be critical to achieving HCV elimination.