Background: Only a minority of HCV-infected individuals are treated. Substance abuse, medical and psychiatric comorbidities are cited as common reasons for not referring or treating. We reviewed a cohort of newly HCV-diagnosed individuals to determine reasons for not referring or treating during the transition to interferon (IFN)-free treatment and to explore the effects of eliminating referral contraindications.
Methods: Individuals born 1945 – 1965 were screened for HCV in two community clinics. Demographics, comorbid medical disease, mental illness, substance abuse, FIB-4 scores and HCV treatment course were retrieved by chart review. Comorbid medical disease was defined as COPD, active malignancy, autoimmune disease on immunosuppression, creatinine >2.0mg/dL or HgbA1c >7.5% based on WHO's contraindications to IFN/ribavirin. Substance abuse was defined by self-report or positive urine toxicology during the study period.
Results: From 01/2013 – 11/2014, 250 individuals were diagnosed with chronic HCV. Median age was 56 years, 40% were female, 60% African American, and 18% Hispanic. Median FIB-4 score was 1.4 (IQR 0.9-2.1). Eighty-two (32%) were referred to HCV clinic, 59 (23%) attended, and 5 (2%) started HCV treatment over a 2 year follow-up period (01/2013 – 02/2015). The most common reasons for not referring were substance abuse and medical disease (Figure 1). Of those referred, the most common reason for not treating was lack of advanced disease. Individuals with substance abuse were less likely to be referred (p<0.005), but if referred were equally likely to attend (p=0.2) Figure 2. If all restrictions to referral were eliminated, 96 additional individuals could have been referred (56%) Figure 3.
Conclusion: Through birth cohort screening, more individuals will be diagnosed with chronic HCV infection. Referral restrictions may limit access to treatment among eligible individuals. With shorter, well-tolerated HCV treatments, traditional reasons for non-referral are less applicable. However, we found that these traditional reasons are still commonly utilized, in particular substance abuse and comorbid medical disease. Eliminating historic contraindications to referral may significantly increase treatment rates.
R. Hanratty, None
A. Truesdale, None
S. Rowan, None