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HCV Cascade of Care for mono & HIV coinfected
  from Jules: these studies report significant barriers to care for certain patient populations. Several of these studies examine inner city marginalized difficult patient populations including substance abusers and ethnic minorities, and identify significant barriers to care. Sure once we have easy to tolerate IFN-free short-duration & highly effective HCV DAA therapies I think rates of care & treatment certainly will improve overall. But in these marginalized patient populations discussed here, for example HCV/HIV coinfected at CORE Clinic in Chicago which represents other similar inner big city HIV & non-HIV clinics & communities, for these communities the barriers to care will I think continue to persist at a significant level for a significant number of HCV+ individuals. Ways to overcome these barriers will have to be identified, the major barrier is the difficulty in engagement to care, all too often there is a strong resistance to engage in care, for various reasons.
The CORE HCV Cascade a Decade Later: Looking Ahead to an IFN-free Era - (03/24/14)....the vast majority of HCV/HIV connected in Chicago Inner City clinic have NOT been evaluated nor treated for HCV....adherence with clinic visits major reason, poor efficacy & side effects of interferon also a factor....engagement, retention to care & reimbursement are crucial & must be improved
High Hepatitis C Infection Rate in Birth Cohort Testing of an Urban, Primary Care Clinic Population: HCV Cascade, 8.2% Prevalence - (03/24/14).....very high 8.2% HCV prevalence in this Wash DC inner city clinic, 14% among African-American men, 90% African-Americans is much higher than Birth Cohort CDC reported rate of 3.2% & overall previously reported rate of 2% in Wash DC
DDW: The Tip of an Iceberg - Who Is Known to Have Hepatitis C? - 'majority remain undiagnosed, especially in younger men outside the birth cohort....birth-cohort & risk based screening needed.....30-49 age.....88-65% remain undiagnosed....less than 33% overall were diagnosed with HCV.....prevalence 1-3.3%' - (05/08/14)
Impact of Rapid Hepatitis C testing on Receipt of Hepatitis C Results in a Public STD Clinic - (03/24/14).....rapid HCV testing in inner city Baltimore public STD clinic, 80-90% African-American, improves capacity to deliver counseling, linkage-to-care
The burden of hepatitis C infection in Pennsylvania state prisons and implications for treatment - (03/24/14) 17% HCV prevalence for men, 31% for women
The Treatment Cascade for People with Chronic Hepatitis C Virus Infection in the United States - (03/24/14)....50% diagnosed & aware....27% confirmed HCV -RNA.....16% prescribed treatment...9% achieved SVR http://www.natap.org/2014/HCV/071414_04.htm
Implementation of a Hepatitis C testing program in a network of Federally Qualified Health Centers: initial results of an Academic-Community partnership - (03/24/14)....barriers to care in San Diego...public health FQHC clinics...residential alcohol, substance abuse facilities ......20% HCV+ upon testing....only 58% fell within Baby Boomer age group
The Hepatitis C Cascade of Care Among HIV Infected Patients Following Diagnosis of HCV Infection - (03/24/14) in San Diego at HIV Owen Clinic UCSD...of those in HIV Care & with antibody HCV test only 54% referred for HCV treatment.....16% initiated treatment....7% cured....barriers to HCV care included "not engaged in care", "unstable housing", having "low CD4 count", BUT having psych issues was a positive, that is they were more likely to be referred to care
DDW: Bridging the Gap between HCV Screening and Access to Care: Insights from National Health and Nutrition HCV Follow-up Study, 2001-2010 - (05/08/14).......About 50% of patients did not know of their HCV positive status before notification. About 80% had seen a doctor or had an upcoming appointment regarding their test results. Factors associated with patients not having pursued further care after notification included having no insurance, IV drug use, smoking, not having a consistent source of obtaining their medical care, an increasing family size, living below poverty index ratio and living in the US for less than 10 years. Individuals who pursued further care were more knowledgeable regarding transmission and health related complications of HCV infection. In the multivariate model, the only predictor of pursuing further management after diagnosis for HCV was having health care insurance.
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