1. Direct-Acting Antiviral Hepatitis C Treatment Cascade and Barriers to Treatment Initiation Among US Men and Women With and Without HIV.
- Author
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Haley, Danielle F, Edmonds, Andrew, Ramirez, Catalina, French, Audrey L, Tien, Phyllis, Thio, Chloe L, Witt, Mallory D, Seaberg, Eric C, Plankey, Michael W, Cohen, Mardge H, and Adimora, Adaora A
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HEPATITIS C ,CLINICAL trial registries ,HIV ,HEPATITIS C virus ,ANTIVIRAL agents ,HIV infection complications ,HIV infections ,RESEARCH ,CHRONIC hepatitis C ,RESEARCH methodology ,HEPATITIS viruses ,EVALUATION research ,COMPARATIVE studies ,MIXED infections ,RESEARCH funding ,HEALTH equity ,AIDS ,LONGITUDINAL method ,DISEASE complications - Abstract
Background: People with HIV are disproportionately coinfected with hepatitis C virus (HCV) and experience accelerated liver-related mortality. Direct-acting antivirals (DAAs) yield high sustained virologic response (SVR) rates, but uptake is suboptimal. This study characterizes the DAA-era HCV treatment cascade and barriers among US men and women with or at risk for HIV.Methods: We constructed HCV treatment cascades using the Women's Interagency HIV Study (women, 6 visits, 2015-2018, n = 2447) and Multicenter AIDS Cohort Study (men, 1 visit, 2015-2018, n = 2221). Cascades included treatment-eligible individuals (ie, HCV RNA-positive or reported DAAs). Surveys captured self-reported clinical (eg, CD4), patient (eg, missed visits), system (eg, appointment access), and financial/insurance barriers.Results: Of 323/92 (women/men) treatment eligible, most had HIV (77%/70%); 69%/63% were black. HIV-positive women were more likely to attain cascade outcomes than HIV-negative women (39% vs 23% initiated, 21% vs 12% SVR); similar discrepancies were noted for men. Black men and substance users were treated less often. Women initiating treatment (vs not) reported fewer patient barriers (14%/33%). Among men not treated, clinical barriers were prevalent (53%).Conclusions: HIV care may facilitate HCV treatment linkage and barrier navigation. HIV-negative individuals, black men, and substance users may need additional support.Clinical Trials Registration: NCT00000797 (Women's Interagency HIV Study); NCT00046280 (Multicenter AIDS Cohort Study). [ABSTRACT FROM AUTHOR]- Published
- 2021
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