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Abstract: Introduction: Hepatitis C (HCV) is a virus transmitted through blood and bodily fluid that, if left untreated, can lead to liver cirrhosis, hepatic cancer, and death [1]. However, the development of highly effective direct-acting antivirals (DAAs) and a standard cascade of care protocol have led to increases in the percentage of patients who achieve sustained virologic response (SVR). However, significant barriers including housing instability [2, 3] and drug use [2, 3] are associated with a lower likelihood of achieving SVR [3]. The Rhode Island Department of Health has determined that eliminating HCV is a priority area. The purpose of this study is to (1) identify the proportion of patients with HCV viremia who do and do not achieve (SVR) in Rhode Island and to (2) identify demographic and health factors that influence the initiation and completion of the HCV care cascade in Rhode Island to inform interventions in the state. Methods: Demographic, clinical, and social determinants were extracted from the electronic health record (EHR). Descriptive analyses were conducted using Chi-square, Fisher’s exact, and Student’s t-tests to compare characteristics between individuals who achieved or did not achieve SVR. Standardized mean differences (SMD) were calculated to assess balance between groups, with |SMD| ≥ 0.10 indicating meaningful imbalance. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with incomplete treatment. When applicable, the models were adjusted by age, gender, race, ethnicity, insurance. Analyses were conducted using SAS version 9.4 (SAS Institute Inc., Cary, NC). Results: We identified 1039 eligible patients with HCV viremia within the Brown University Health System in Rhode Island between January 1 and December 31, 2018 (mean age 49.4 ± 12.8 years; 61.6% male). 608 (58.5%) achieved SVR and 431 (41.5%) did not achieve SVR. Achievement of SVR was more frequent among white patients compared to Hispanic (18.7% vs. 13.0%, OR 1.57, 95% CI 1.10–2.22) and Black patients (17.0% vs. 12.2%, 1.47 [1.02–2.13]). Patients with housing instability had higher odds of not achieving SVR (OR: 1.91 [1.22-2.98)]. People who use cocaine and opioids had lower odds of achieving SVR (cocaine OR: 1.76[1.21-2.61]; opioid OR: 1.67 [1.28-2.28]). Patients with commercial insurance had higher odds of achieving SVR (OR: 0.59 [0.38-0.90]). Discussion: The results underscore the systemic and structural factors that alter the ability of individuals to complete the HCV care cascade.
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Identifier: DOI: 10.26300/s35x-pa26