BACKGROUND: Without treatment, chronic hepatitis C virus (HCV) infection can lead to cirrhosis, liver failure, hepatocellular carcinoma, and death. Direct-acting antiviral medications with short treatment duration leads to >95% cure rates. However, cost, insurance restrictions, and other barriers to access may limit treatment and perpetuate inequalities. We assessed demographic factors associated with treatment initiation and cure in New York City (NYC).
METHODS: For persons newly diagnosed with HCV in NYC in 2015, treatment and cure were assessed using laboratory-reported HCV positive and negative RNA test results from our surveillance registry as of November 21, 2016. Treatment initiation was defined as a positive RNA test result and a negative result for the most recent RNA test. Cure was defined relative to the date of the first negative, indeterminate, or low-positive RNA test result: one positive RNA result must have been before this date and two negative RNAs and no positive RNA after this date. Multivariable logistic regression was used to identify adjusted odds ratios (aORs) for factors associated with treatment initiation and cure, adjusting for sex, age at HCV diagnosis, incarceration at diagnosis, and ZIP code-based poverty.
RESULTS: Of 7,224 persons newly reported with HCV in 2015, 80% received an RNA confirmatory test. Of those, 76% had a positive RNA result, 30% of whom initiated treatment. Of those initiating treatment, 47% had evidence of cure. Among those with a positive RNA result: men (aOR 0.78, 95% CI 0.68–0.90); persons 20-29 (aOR 0.67, 95% CI 0.52–0.87) or ≥80 years-old (aOR 0.30, 95% CI 0.17–0.53) versus 60-69 year-olds; persons living in high (aOR 0.74, 95% CI 0.59–0.93) or very high poverty (aOR 0.64, 95% CI 0.51–0.82) versus low poverty neighborhoods; and incarcerated persons (aOR 0.13, 95% CI 0.09–0.18) had lower odds of initiating treatment. Among those initiating treatment, incarcerated persons (aOR 0.10, 95% CI 0.05–0.23) and persons 20-29 (aOR 0.46, 95% CI 0.31–0.67) or ≥80 years-old (aOR 0.38, 95% CI 0.18–0.78) had lower odds of cure.
CONCLUSIONS: Surveillance data can be used to identify disparities in HCV treatment and cure, which are attributable to disparities in access to care. Incarcerated persons had lower odds of initiating treatment and achieving cure, although surveillance data may not capture treatment history for persons transferred out of jurisdiction. Increased efforts to treat persons <30 years-old, presumably recently infected, are needed to prevent further transmission through ongoing risk practices.