Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model
Background: Direct acting antivirals (DAAs) have simplified and expanded access to Hepatitis C virus (HCV) treatment. Only 17% of the 2.4 million Americans with HCV have linked to HCV care. We aimed to evaluate linkage to care (LTC) in a non-urban HCV referral clinic with a nurse navigator model and...
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doaj-e8e1f6d88dd341ef84549f38b419dbd92020-11-25T00:44:42ZengFrontiers Media S.A.Frontiers in Public Health2296-25652019-11-01710.3389/fpubh.2019.00362488745Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator ModelJacqueline E. Sherbuk0Kathleen A. McManus1Terry Kemp Knick2Chelsea E. Canan3Tabor Flickinger4Rebecca Dillingham5Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United StatesDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United StatesDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United StatesDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United StatesDepartment of Medicine, University of Virginia, Charlottesville, VA, United StatesDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United StatesBackground: Direct acting antivirals (DAAs) have simplified and expanded access to Hepatitis C virus (HCV) treatment. Only 17% of the 2.4 million Americans with HCV have linked to HCV care. We aimed to evaluate linkage to care (LTC) in a non-urban HCV referral clinic with a nurse navigator model and identify disparities in LTC.Methods: A single-center retrospective cohort analysis was performed among all patients referred to an infectious diseases HCV clinic between 2014 and 2018. The primary outcome was LTC, defined as attendance at a clinic appointment. A multivariable Poisson regression model estimated the association of variables with LTC.Results: Among 824 referred patients, 624 (76%) successfully linked to care and 369 (45%) successfully achieved sustained virologic response. Forty-six percent of those referred were uninsured. On multivariable analysis, LTC rates were higher among women (Incidence Rate Ratio [IRR] 1.11, 95% CI 1.03–1.20, p-value = 0.01) and people with cirrhosis (IRR 1.20, 95% CI 1.11–1.30, p-value < 0.001). Lower LTC rates were found for young people (<40 years; IRR 0.88, 95% CI 0.79–0.98, p-value = 0.02) and uninsured people (IRR 0.85, 95% CI 0.77–0.94, p-value = 0.002). Among those without LTC, 10% were incarcerated. Race, proximity to care, substance use, and HIV status were not associated with LTC.Conclusions: Using an embedded nurse navigator model, high LTC rates were achieved despite the prevalence of barriers, including a high uninsured rate. Disparities in LTC based on age, sex, and insurance status are present. Substance use was not associated with LTC. Future interventions to improve care should include expanded access to insurance and programs bridging care for incarcerated populations.https://www.frontiersin.org/article/10.3389/fpubh.2019.00362/fullhepatitis Clinkage to carecascade of carehealth disparitiessubstance use disorder |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jacqueline E. Sherbuk Kathleen A. McManus Terry Kemp Knick Chelsea E. Canan Tabor Flickinger Rebecca Dillingham |
spellingShingle |
Jacqueline E. Sherbuk Kathleen A. McManus Terry Kemp Knick Chelsea E. Canan Tabor Flickinger Rebecca Dillingham Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model Frontiers in Public Health hepatitis C linkage to care cascade of care health disparities substance use disorder |
author_facet |
Jacqueline E. Sherbuk Kathleen A. McManus Terry Kemp Knick Chelsea E. Canan Tabor Flickinger Rebecca Dillingham |
author_sort |
Jacqueline E. Sherbuk |
title |
Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model |
title_short |
Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model |
title_full |
Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model |
title_fullStr |
Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model |
title_full_unstemmed |
Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model |
title_sort |
disparities in hepatitis c linkage to care in the direct acting antiviral era: findings from a referral clinic with an embedded nurse navigator model |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Public Health |
issn |
2296-2565 |
publishDate |
2019-11-01 |
description |
Background: Direct acting antivirals (DAAs) have simplified and expanded access to Hepatitis C virus (HCV) treatment. Only 17% of the 2.4 million Americans with HCV have linked to HCV care. We aimed to evaluate linkage to care (LTC) in a non-urban HCV referral clinic with a nurse navigator model and identify disparities in LTC.Methods: A single-center retrospective cohort analysis was performed among all patients referred to an infectious diseases HCV clinic between 2014 and 2018. The primary outcome was LTC, defined as attendance at a clinic appointment. A multivariable Poisson regression model estimated the association of variables with LTC.Results: Among 824 referred patients, 624 (76%) successfully linked to care and 369 (45%) successfully achieved sustained virologic response. Forty-six percent of those referred were uninsured. On multivariable analysis, LTC rates were higher among women (Incidence Rate Ratio [IRR] 1.11, 95% CI 1.03–1.20, p-value = 0.01) and people with cirrhosis (IRR 1.20, 95% CI 1.11–1.30, p-value < 0.001). Lower LTC rates were found for young people (<40 years; IRR 0.88, 95% CI 0.79–0.98, p-value = 0.02) and uninsured people (IRR 0.85, 95% CI 0.77–0.94, p-value = 0.002). Among those without LTC, 10% were incarcerated. Race, proximity to care, substance use, and HIV status were not associated with LTC.Conclusions: Using an embedded nurse navigator model, high LTC rates were achieved despite the prevalence of barriers, including a high uninsured rate. Disparities in LTC based on age, sex, and insurance status are present. Substance use was not associated with LTC. Future interventions to improve care should include expanded access to insurance and programs bridging care for incarcerated populations. |
topic |
hepatitis C linkage to care cascade of care health disparities substance use disorder |
url |
https://www.frontiersin.org/article/10.3389/fpubh.2019.00362/full |
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