Has Access to Hepatitis C Virus Therapy Changed for Patients With Mental Health or Substance Use Disorders in the Direct-Acting-Antiviral Period?
Has Access to Hepatitis C Virus Therapy Changed for Patients With Mental Health or Substance Use Disorders in the Direct-Acting-Antiviral Period?
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DOI：
10.1002/hep.30171
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发表时间：
2019-01-01
期刊：
影响因子：
13.5
通讯作者：
Wong, Robert J.
中科院分区：
文献类型：
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作者：
Jain, Mamta K.;Thamer, Mae;Wong, Robert J.
丙型肝炎病毒（HCV）的直接作用抗病毒药物（DAA）于2014年上市，但精神健康或物质使用障碍（MH/SUD）在获得治疗方面的作用尚不清楚。本研究的目的是检查美国四个大型、不同的医疗机构在daa前和daa后期间HCV治疗的程度和预测因素。我们对2011年1月1日至2017年2月28日期间接受或未接受治疗的29,544名慢性HCV成人患者进行了回顾性分析。采用Kaplan-Meier曲线对接受HCV治疗按MH/SUD分层的累积风险进行检验。使用多元广义估计方程和修正泊松模型分析daa前（2011年1月1日至2013年12月31日）和daa后（2014年1月1日至2017年2月28日）队列中HCV治疗的预测因子。总体而言，daa后21.7%（2879 / 13240）的慢性HCV患者接受了治疗，而daa前的这一比例为3.5%（574/ 16304）。与非西班牙裔白人相比，西班牙裔白人（调整优势比[AOR] 0.36； 95%可信区间[CI]， 0.25, 0.52）在daa后接受治疗的可能性较小。合并非酒精性脂肪性肝病（AOR 1.39; 95% CI, 1.05, 1.83）、肝硬化（AOR 2.00; 95% CI, 1.74, 2.31）和肝移植（AOR 2.72; 95% CI, 1.87, 3.94）的患者更有可能在daa后接受治疗。在使用DAA治疗之前（AOR 0.46; 95% CI, 0.36, 0.60）和之后（AOR 0.63; 95% CI, 0.55, 0.71）， MH/SUD患者接受DAA治疗的可能性都较小。总体而言，2011年至2017年，MH/SUD患者接受HCV治疗的累积风险分别为13.6%和21.6% （P < 0.001）。结论：在daa后，HCV治疗患者的数量有所增加，特别是那些有肝脏相关合并症的患者，但MH/SUD患者在获得治疗方面的差异仍然存在。
Direct-acting antivirals (DAA) for hepatitis C virus (HCV) became available in 2014, but the role of mental health or substance use disorders (MH/SUD) on access to treatment is unknown. The objective of this study was to examine the extent and predictors of HCV treatment in the pre-DAA and post-DAA periods in four large, diverse health care settings in the United States. We conducted a retrospective analysis of 29,544 adults with chronic HCV who did or did not receive treatment from January 1, 2011, to February 28, 2017. Kaplan-Meier curve was used to examine cumulative risk for receiving HCV treatment stratified by MH/SUD. Predictors of HCV treatment in the pre-DAA (January 1, 2011, to December 31, 2013) and post-DAA (January 1, 2014, to February 28, 2017) cohorts were analyzed using multivariate generalized estimating equations and a modified Poisson model. Overall, 21.7% (2,879/13,240) of those with chronic HCV post-DAA were treated compared with 3.5% (574/16,304) in the pre-DAA period. Compared with non-Hispanic whites, Hispanic whites (adjusted odds ratio [AOR] 0.36; 95% confidence interval [CI], 0.25, 0.52) were less likely to be treated in the post-DAA period. Those with concurrent nonalcoholic fatty liver disease (AOR 1.39; 95% CI, 1.05, 1.83), cirrhosis (AOR 2.00; 95% CI, 1.74, 2.31), and liver transplant (AOR 2.72; 95% CI, 1.87, 3.94) were more likely to be treated post-DAA. Those with MH/SUD were less likely to be treated both before (AOR 0.46; 95% CI, 0.36, 0.60) and after (AOR 0.63; 95% CI, 0.55, 0.71) DAA therapy was available. Overall, the cumulative risk for receiving HCV treatment from 2011 to 2017 among those with versus without MH/SUD was 13.6% versus 21.6%, respectively (P < 0.001). Conclusion: The volume of patients treated for HCV has increased in the post-DAA period, especially among those with liver-related comorbidities, but disparities in access to treatment continue among those with MH/SUD.