Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

• Published in: Hepatology communications 2021-03, Vol.5 (3), p.400-411
• Main Authors: Spradling, Philip R., Zhong, Yuna, Moorman, Anne C., Rupp, Loralee B., Lu, Mei, Gordon, Stuart C., Teshale, Eyasu H., Schmidt, Mark A., Daida, Yihe G., Boscarino, Joseph A., Holmberg, Scott D, Teshale, Eyasu H, Spradling, Philip R, Moorman, Anne C, Xing, Jian, Gordon, Stuart C, Nerenz, David R, Lamerato, Lois, Li, Jia, Rupp, Loralee B, Akkerman, Nonna, Oja‐Tebbe, Nancy, Zhang, Talan, Trudeau, Sheri, Zhou, Yueren, Boscarino, Joseph A, Daar, Zahra S, Smith, Robert E, Daida, Yihe G, Trinacty, Connie M, Wong, Carmen P, Schmidt, Mark A, Donald, Judy L, Keast, Erin M
• Format: Article
• Language: English
• Subjects: Adult; Alcohol use; Antiviral Agents - therapeutic use; Black or African American - psychology; Comorbidity; Electronic health records; Employment; Female; Generalized anxiety disorder; Health care access; Health Services Accessibility - statistics & numerical data; Health Surveys; Healthcare Disparities - ethnology; Hepacivirus; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C - ethnology; Hepatitis C - psychology; Humans; Infections; Laboratories; Liver; Liver cirrhosis; Male; Middle Aged; Odds Ratio; Original; Patient Acceptance of Health Care - psychology; Patients; Polls & surveys; Productivity; Psychosocial Functioning; Quality of life; Quality of Life - psychology; Questionnaires; Social support; United States; White People - psychology
• ISSN: 2471-254X; 2471-254X
• DOI: 10.1002/hep4.1632

There are limited data examining the relationship between psychosocial factors and receipt of direct‐acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health‐related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017‐2018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow‐up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life‐related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow‐up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). Conclusion: In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C‐related morbidity and mortality. Even among persons with access to care, receipt of direct‐acting antiviral treatment for hepatitis C is suboptimal. We therefore conducted a detailed psychological, behavioral, and social survey among hepatitis C patients in care to determine whether such factors were associated with DAA initiation. Compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments, suggesting that such factors should be addressed to reduce hepatitis C‐related morbidity and m