Eliminating Structural Barriers: The Impact of Unrestricted Access on Hepatitis C Treatment Uptake Among People Living With Human Immunodeficiency Virus
| Autor: | John Gill, Alexander Wong, Mark W. Tyndall, Sahar Saeed, Sharon Walmsley, Brian Conway, Leo Wong, Curtis Cooper, Erin Strumpf, Joseph Cox, Valérie Martel-Laferrière, Mark W. Hull, Marie-Louise Vachon, Marina B. Klein, Erica E. M. Moodie |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Microbiology (medical)
Canada Hepatitis C virus people who inject drugs HIV Infections medicine.disease_cause Rate ratio Antiviral Agents 03 medical and health sciences symbols.namesake 0302 clinical medicine Medicine Humans 030212 general & internal medicine Poisson regression Substance Abuse Intravenous Generalized estimating equation Articles and Commentaries direct-acting antivirals business.industry HIV–hepatitis C coinfection unrestricted access HIV Hepatitis C Hepatitis C Chronic medicine.disease Confidence interval 3. Good health Infectious Diseases AcademicSubjects/MED00290 Cohort symbols Coinfection quasi-experimental methods 030211 gastroenterology & hepatology business Demography |
| Zdroj: | Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background High costs of direct-acting antivirals (DAAs) have led health-care insurers to limit access worldwide. Using a natural experiment, we evaluated the impact of removing fibrosis stage restrictions on hepatitis C (HCV) treatment initiation rates among people living with human immunodeficiency virus (HIV), and then examined who was left to be treated. Methods Using data from the Canadian HIV-HCV Coinfection Cohort, we applied a difference-in-differences approach. Changes in treatment initiation rates following the removal of fibrosis stage restrictions were assessed using a negative binomial regression with generalized estimating equations. The policy change was then specifically assessed among people who inject drugs (PWID). We then identified the characteristics of participants who remained to be treated using a modified Poisson regression. Results Between 2010–2018, there were a total of 585 HCV initiations among 1130 eligible participants. After removing fibrosis stage restrictions, DAA initiations increased by 1.8-fold (95% confidence interval [CI] 1.3–2.4) controlling for time-invariant differences and secular trends. Among PWID the impact appeared even stronger, with an adjusted incidence rate ratio of 3.6 (95% CI 1.8–7.4). However, this increased treatment uptake was not sustained. At 1 year following universal access, treatment rates declined to 0.8 (95% CI .5–1.1). Marginalized participants (PWID and those of indigenous ethnicity) and those disengaged from care were more likely to remain HCV RNA positive. Conclusions After the removal of fibrosis restrictions, HCV treatment initiations nearly doubled immediately, but this treatment rate was not sustained. To meet the World Health Organization elimination targets, the minimization of structural barriers and adoption of tailored interventions are needed to engage and treat all vulnerable populations. People coinfected with human immunodeficiency virus and hepatitis C virus were 1.8 times more likely to initiate treatments after fibrosis stage restrictions were removed, after controlling for temporal trends. Marginalized populations and those disengaged from care remain to be treated. |
| Databáze: | OpenAIRE |
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